EMINENT DOCTORS.

Ballantyne Press

BALLANTYNE, HANSON AND CO.
EDINBURGH AND LONDON

EMINENT DOCTORS:
Their Lives and their Work.

BY

G. T. BETTANY, M.A. (Camb.), B.Sc. (Lond.), F.L.S.

AUTHOR OF “FIRST LESSONS IN PRACTICAL BOTANY,”
“ELEMENTARY PHYSIOLOGY,” ETC.
AND LECTURER ON BOTANY IN GUY’S HOSPITAL MEDICAL SCHOOL.

“There is to me an inexpressible charm in the lives of the good, brave, learned men, whose only objects have been, and are, to alleviate pain and to save life.”

—G. A. Sala.

IN TWO VOLUMES.
VOL. II.

LONDON:
JOHN HOGG, PATERNOSTER ROW.

[All rights reserved.]

CONTENTS OF VOL. II.

EMINENT DOCTORS.

[CHAPTER XI.]
ADDISON, BRIGHT, AND THE DISEASES WHICH BEAR THEIR NAMES.

Operative dexterity, as was natural, arrived more quickly at perfection than did medical treatment. In fact, no one will pretend that medicine has yet travelled far, in comparison with its future achievements, when physiology, pathology, and therapeutics shall have become more complete. Thomas Addison is a specimen of the physicians of genius who have adorned this century. He is known as the discoverer of a disease which bears his name; but his true fame rests upon his practical talent in diagnosing disease.

Dr. Lonsdale, in his volume of “Worthies of Cumberland,” issued in 1873, shows that Addison sprang from the ranks of the yeomanry of Cumberland, and that his forefathers resided during the Commonwealth at “The Banks,” in the parish of Lanercost. Thomas Addison, born in 1636, and Mary his wife, have left their initials carved on an old oaken settle still preserved at The Banks, inscribed with the injunction, “When God doth thee in store, remember thou the poor.” One of his descendants was a Samuel Addison, who became a doctor of medicine, but died at the age of thirty-four. Thomas Addison, a nephew of his, was born in April 1793, at Longbenton, near Newcastle-on-Tyne, where his father was in business, though he retained his farm at The Banks, where his wife lived for the most part. Young Addison clung greatly to the ancestral home, and many years afterwards assembled his wedding guests there. It is on the very site where the Romans encamped during the building of the wall to the Solway Firth; it overlooks the medieval Priory of Lanercost; near by is Naworth, the old Border castle of “Belted Will Howard.”

Thomas Addison was educated at the Newcastle grammar-school under the Rev. E. Moises, and there became a masterly Latin scholar, so that he afterwards took his lecture notes in Latin at Edinburgh. He went direct from school to Edinburgh University, declining to enter as a pupil with an Edinburgh doctor, as his father desired. He was no ordinary student. Independent in thought and action, he was soon recognised by the Royal Medical Society, and made one of its presidents in 1814, an honour which Marshall Hall, and Richard Bright his subsequent colleague, also attained about that time. A striking fact it is that three of the first names of great English physicians of this century should be Edinburgh students, and Presidents of the same Medical Society there. But as yet the London medical schools were only in embryo.

Addison took his M.D. degree in 1815, and afterwards, it is believed, visited the Continental schools; but of this there is no certain evidence. He soon settled in London, in Skinner Street, Snow Hill, in one of the so-called haunted houses. He knew but one man, an old fellow-student, in London. Yet he received nearly sixty guineas in his first year of practice, a very considerable success. He became House Surgeon to the Lock Hospital; then Physician to the General Dispensary, where he studied skin diseases with Bateman. This appointment he held for eight years, and it was of essential service to him. He manifested a keen eye for generic distinctions and individual varieties, and might probably have succeeded to Bateman’s position in regard to skin diseases. But he was not to be made into a specialist. As Dr. Lonsdale says, “with Addison the investigation of any disease meant the full exercise of his abilities till he had mastered it, and having done this, he could not rest till he broke up fresh ground for tillage.” He dreaded becoming a specialist; it savoured of quackery. He always held that the true physician must understand surgery well; and that the good surgeon must know the principles of medicine.

In 1819 or 1820 commenced Addison’s association with Guy’s. He early attracted the attention of the energetic and discerning treasurer, Mr. Harrison, then the beneficent despot of Guy’s, and was by him appointed Assistant-Physician in 1824. This was a victory for unconventional procedure, for it had always been the custom to appoint men at Guy’s who had been original pupils, and not to receive men who were already qualified and in practice into the charmed circle. It was soon evident that a great practical physician had joined the hospital staff, and he was further recognised in 1827 by receiving the lectureship of Materia Medica. Here his attractive powers were made evident by the large classes he drew around him, at a period when medical students entered for individual courses of lectures, and did not as a rule take the whole of their instruction at one school. He must have received between £700 and £800 from these lectures in some years. Men felt that he was the man to sustain and increase the fame of Guy’s.

In 1829 Dr. Addison published, in conjunction with John Morgan, Surgeon to Guy’s, an essay on “The Operation of Poisonous Agents on the Living Body.” Strange to say, this was the first serious investigation in England into the phenomena of general poisoning. The authors believed that a direct influence on the nerve filaments distributed to the blood-vessels accounts for the rapid effects of some of them. In 1830, Addison published a pamphlet on some disorders of females, vigorously combating some received notions, and objecting to the system of depletion. In concluding a lengthy lecture to his class on this subject, he showed the sentiments which animated him by the following remarks: “Gentlemen, if you require an apology for detaining you so long, I find ample material for that apology in the lively interest in which we must all feel in the comfort and happiness of the other sex, doomed as they are, both by the decrees of Providence and by human institutions, to drink deep of the bitter cup of suffering. Whatever may be her lot in this world, we, as men, must at least acknowledge that, whilst Infinite Power gave us being, Infinite Mercy gave us women.”

In 1837 Addison was elected full Physician to the Hospital, and was appointed joint-lecturer with Dr. Bright on Medicine. About this time he commenced with his colleague the “Elements of the Practice of Medicine,” of which the first volume only appeared, chiefly written by Addison. It was most highly valued, but neither author could be induced to complete it. Valuable monographs in number came from his rich experience: two on Pneumonia in 1837 and 1843; Observations on the Anatomy of the Lungs in 1840; the Pathology of Phthisis, 1845, in which he laid down the principle that inflammation constitutes the first instrument of destruction in every form of phthisis. This early advocacy of a doctrine which has thrown much light on this disease was strongly opposed by the physicians of his day, and stamped Addison as a powerful innovator. He was much impressed by Laennec’s views, and acquired very great power of diagnosing from auscultation of the chest. Yet, candid ever in confessing ignorance, he read a paper before Guy’s Physical Society in 1846, “On the Difficulties and Fallacies attending Physical Diagnosis of Diseases of the Chest.” Among other subjects, he dealt with Diseases of the Liver, Affections of the Skin, Disorders of the Brain connected with Diseased Kidneys, and “the Influence of Electricity as a Remedy in certain Convulsive and Spasmodic Diseases,” in every case bringing together facts hitherto disconnected, and contributing markedly to advance medicine as a science.

The achievement of Dr. Addison, however, which has attracted most general notice, is his discovery of a disease of the supra-renal capsules, the small organs adjacent to the kidneys, whose function has not yet been satisfactorily ascertained. We are told that in one case, which had baffled all investigation, Addison was called in, and after careful enquiry, stated positively that the patient suffered from a disease of these organs, which would before long prove fatal. This opinion was received with polite incredulity, but it was justified by the result, and the supra-renal capsules were the only organs that were found diseased. This extraordinary diagnosis was soon noised abroad, and on the Continent brought Addison more honour than in England. Trousseau in France was cordially supported in naming it “la Maladie d’Addison” (Addison’s disease), a name which it will long retain. But the disease was not discovered in this apparently sudden and striking manner, but was the result of observations carried on for many years, in which his powers of deduction from a few cases and imperfect data were most strikingly evidenced. The disease occurs rarely, and very few hints or materials for comparison were available. A form of wasting disease without any apparent organic injury had been again and again observed—bloodlessness, extreme prostration, and various shades of alteration in the colour of the skin, being prominent symptoms. A certain bronzing of the integument was, and still is, an inexplicable concomitant, and no light was thrown upon it till Addison, carefully examining the organs of a deceased patient, when no other disease could be detected, discovered signs of malady in the supra-renal capsules. He identified the disease, and though he did not absolutely mark it out from all others, he gave a very perfect account of the symptoms in the cases which he had met with, and showed that no other disease could be connected with them—indeed no other disease of these capsules has been discovered.

As a teacher Addison was impressive and popular. His interest in his class was genuine and unfeigned; he was eager to draw out the talents of his students. Among his pupils were Dr. Golding Bird, too early called from his brilliant career, Sir William Gull, Dr. Wilks, and many others of note. His clinical teaching in the wards was especially superior. He could most vividly illustrate on the patient, and most clearly define and demonstrate his disease. He disliked anything like interference with his methods by others, and sometimes showed it somewhat brusquely. Once when he had been away from his wards for a few days, a colleague had seen reason to change his treatment of a case of pleurisy. On Addison’s return, he at once inquired the reason, and was told that the physician in charge believed the case to be one of pneumonia and solidification of the lung. “Ah indeed!” said Addison, “give me a trocar;” and he immediately plunged the little instrument into the chest, and drew off a few ounces of fluid, proving the accuracy of his own diagnosis. He wasted no time in considering or discussing probabilities; he was certain, and he proved that he was right.

Dr. Wilks’ view of Addison’s character, in the collected edition of his works published by the New Sydenham Society, 1868, is so pertinent that it must find a place in any adequate account of Addison:—

“His strong, positive, and perpetual insistence upon the term ‘practical,’ in reference to disease, constitutes, indeed, the key to Addison’s character and professional career. He was always ready to discuss newly-started theories, but he never for a moment allowed them to interfere with the results of his matured experience. Possessing unusually vigorous perceptive powers, being shrewd and sagacious beyond the average of men, the patient before him was scanned with a penetrating glance, from which few diseases could escape detection. He never reasoned from a half-discovered fact, but would remain at the bedside, with a dogged determination to track out the disease to its very source, for a period which constantly wearied his class and his attendant friends. So severely did he tax his mind with the minutest details bearing upon the exact exposition of a case, that he has been known to startle the ‘sister’ of the ward in the middle of the night by his presence; after going to bed with the case present to his mind, some point of what he considered important detail in reference to it occurred to him, and he could not rest till he had cleared it up. He has also been known, after seeing a patient within the radius of eight or ten miles, to have remembered on his near approach to London, thinking over the case on his way, that he had omitted some seemingly important inquiry, and to have posted back some miles for the purpose of satisfying his mind on the doubt which had occurred to it. If at last he could lay his finger on the disease, his victory was attained, and his painstaking satisfactorily rewarded. For with him accurate diagnosis was the great, and too often the ultimate object of an industry of search, a correlation of facts deduced from scientific observation, and a concentration of thought rarely combined in the individual physician. To those who knew him best, his power of searching into the complex framework of the body, and dragging the hidden malady to light, appeared unrivalled; but we fear that the one great object being accomplished, the same energetic power was not devoted to its alleviation or cure. Without accusing Addison of a meditated neglect of therapeutics, we fancy that we can trace the dallying with remedies which has been the characteristic of more recent times. ‘I have worked out the disease; if it be remediable, nature, with fair play, will remedy it. I do not clearly see my way to the direct agency of special medicaments, but I must prescribe something for the patient, at least, to satisfy his or her friends,’ seems to have been a part of the habit of mind which can deal satisfactorily only with the observable and proven, and shrinks from the uncertain and questionable.”

Addison did not seek to push himself into notoriety. Indeed he seems to have studiously kept himself in the background as regards public life. He took little pains to seek publication of his researches in the medical journals, and for the most part his excellent papers appear in Guy’s Hospital Reports. Thus his practice was not equal to his great merits, though he died worth £60,000. In professional intercourse he appeared blunt, and even at times rude, giving the idea of hauteur and assumption of superiority. The general practitioner was liable to find him unapproachable, and to conceive of him as a man of large self-esteem. Yet underneath this outward semblance lay a most acute nervousness of temperament. This powerful, well-built, energetic, emphatic man concealed a physical nervousness and susceptibility which most deeply affected him in circumstances of trial. He often said, “I never rose to address the Guy’s Junior Physical Society without feeling nervous;” and yet at the same time he appeared to his audience to be speaking in a tone akin even to bluster. His apparent discourtesy was as far as possible from representing his real sentiments. “Viewed in its professional aspect,” says Dr. Wilks, “no character on record has presented in a higher degree the sterling hard qualities of true professional honesty. We have never heard a single instance in which a word of disparagement of a professional brother escaped him. He would always strenuously, and with all his natural vigour, maintain what he believed to be the truth, but never for the purpose of underrating the opinions of others. His whole bearing in the profession was to the last degree honourable, and anything like jealousy or ill-will against another professional man never entered his mind.”

The chief honour outside his school that fell to Addison was the Presidency of the Royal Medical and Chirurgical Society. But court favour did not shine on him, though none would have more worthily received it. On the Continent, as we have before said, Addison was treated with the utmost distinction. When he visited Paris, Nélaton, Trousseau and the élite of the profession entertained him at a public dinner, and gave him the warmest reception. Addison made an eloquent speech in excellent French. He was a zealous Tory, not approving of Disraeli’s modernised policy, but equally removed from Eldon’s tyrannical rule.

Guy’s Museum of Pathology, adorned by an admirable bust of him by Joseph Towne, bears large testimony to Addison’s energy and discernment. He added to it very largely, and his early study of skin diseases led him to suggest and superintend in execution a plan for illustrating skin diseases by wax models, and carefully coloured drawings from life—a process afterwards extended widely through the range of pathology.

“Every feature of Addison’s face,” says Dr. Lonsdale, “was well defined, and comported well with his finely-proportioned massive head. He had dark hair, large eyebrows, and eyes of deep hazel colour; his nose was pronounced, his lips full and voluble, and rather special in action, and his chin firm and broad; and his general physiognomy was stamped with vigour and unmistakable character throughout. He had a deep penetrating eye, that became full of life and light when engaged in debate. Of commanding presence and firm significant step, he possessed a keen penetrativeness, indeed a special discernment that never failed him in private life, and but rarely at the bedside of the sick. He stood before you the impersonation of power and dignity and independence.” Some persons who knew him well believed that he would have had equal success at the bar, in the senate, in the navy or the Church. Whatever he attempted, he would have mastered, and would have carried out, undisturbed by opposition, undeviating in principle.

Dr. Addison did not marry till he was some years over fifty. His wife was the widow of W. W. Hanxwell, Esq. The wedding, in September 1847, took place in Lanercost Church, and was attended by an unusual incident. Just before the ceremony, and unknown to the party, a storm had blown part of the roof of the church on to the altar table. When he saw the wreckage, Addison exclaimed to his biographer, nervously clutching his arm, “Good God, Lonsdale! is this not ominous?” But his friend, suggesting that any part of the building would do for the ceremony, and the bride smilingly showing no diminution of cheerfulness, reassured the doctor, and all went off well. Mrs. Addison, who had two children by her first husband, but none by the second, survived Dr. Addison twelve years. She is described as extremely amiable, and an excellent wife.

In the spring of 1860 Addison was compelled to retire from his hospital duties by a threatening of brain-disease. He settled at Brighton; but his disease progressed, and ended in his death on 29th June 1860. He was buried at Lanercost on the 5th of July. A marble tablet in the chapel of Guy’s Hospital records that he won the admiration and the confidence of the students of the Hospital by his profound knowledge and earnest eloquence: and that he was beloved by the patients for his unwearied attention and kindness to them. One of the medical wards in the new buildings of Guy’s is named after him “Addison Ward.” It is worthy of note that Addison, like John Bell, was a musician, and ready at learning a new instrument. Being slightly deaf in one ear, he was correspondingly acute with the other. This ear he used with surpassing skill in auscultation of the heart and lungs.

In the preface to an edition of Dr. Bright’s “Clinical Memoirs on Abdominal Tumours,” published by the Sydenham Society in 1861, Dr. Barlow well remarks, “There has been no English physician—perhaps it may be said none of any country—since the time of Harvey, who has effected, not only so great an advance in the knowledge of particular diseases, but also so great a revolution in our habits of thought, and methods of investigating morbid phenomena and tracing the etiology of disease, as has the late Dr. Richard Bright. To those who have received the knowledge of the connections of dropsy, albuminous urine, and disease of the kidney, among the first rudiments of medicine, the facts which establish that connection may appear so simple and easily ascertained, that the amount of labour, the accuracy of the observation and the rigid adherence to the inductive method which characterised the whole of Bright’s researches, may hardly have been suspected, still less adequately appreciated.”

Richard Bright was born at Bristol in September 1789, his father being a member of the wealthy banking firm of Ames, Bright, & Cave, and his elder brother subsequently representing Bristol in three parliaments. His early education was conducted by Dr. Estlin, and later by Dr. Carpenter, both names of note in Bristol. In 1808 he entered at Edinburgh University, at first attending Dugald Stewart, Playfair, and Leslie, in whose mathematical class he gained a prize in 1809, commencing the study of medicine under Monro tertius, Hope, and Duncan.

In 1810 Dr. Bright, with Dr. (afterwards Sir Henry) Holland, accompanied Sir George Mackenzie in his journey through Iceland, and contributed notes on botany and zoology, as well as other portions, to “Mackenzie’s Travels in Iceland” (Edinburgh, 1811). Mackenzie acknowledges Bright’s cheerful and ready exertion and undeviating good-humour in the many cross accidents that befel the party. Several times the two medical friends were in imminent danger, and we cannot but be thankful that these lights of medicine were spared to do their life-work.

Returning from Iceland, Bright’s clinical hospital work was commenced at Guy’s Hospital, London, where he lived in the house of a resident officer for two years, a foretaste of the forty years’ residence which he practically made within its walls. Astley Cooper was then in his best form, and young Bright was at once attracted to pathology and post mortem observation. At this early date he made a drawing of a granular kidney, one of the morbid conditions which he was afterwards to do so much to elucidate. In 1812-13 Bright was again a student at Edinburgh, where Gregory was still in full vigour: and he graduated on the 13th September 1813, producing a thesis on Contagious Erysipelas. With the idea of graduating at Cambridge, he entered at Peterhouse, where his brother was a lay-fellow, but he only resided two terms, finding his studies impeded by college discipline. In 1814 Bright was one of the crowd of English voyagers upon the Continent, and made himself conversant with French and German, attending professional lectures especially at Berlin and Vienna. In the spring of 1815 he travelled considerably in Hungary, and the result of his observations, for he was emphatically an observer, was given to the world in his large quarto volume of “Travels from Vienna through Lower Hungary, with Remarks on the State of Vienna during the Congress of 1814,” published at Edinburgh, 1818. This was a most valuable contribution on the social condition, statistics, and natural history of that country, then so little known in England. In all this it is evident how much Dr. Bright’s career was facilitated by the comfortable circumstances in which he was placed pecuniarily: not that money gave him his talent, but that it prevented him from suffering from the obstacles and disadvantages which have attended the career of so many physicians.

Meanwhile, Dr. Bright, in the winter of 1814, had been studying cutaneous diseases under Dr. Bateman at the Dispensary. On his return home through Belgium, about a fortnight after Waterloo, he saw many interesting cases of disease among the sick and wounded from the late contending armies. In December 1816 he was admitted a Licentiate of the London College of Physicians, and was soon after elected assistant-physician to the London Fever Hospital, paying the frequent price of a severe attack of fever, which almost cost him his life. In the summer and autumn of 1818 he again visited the Continent, spending a considerable time in Germany and Italy, and returning through Switzerland and France.

From 1820 we may date Bright’s full entry upon his professional career; for he now took a house in Bloomsbury Square for private practice. His election the same year to the assistant-physiciancy to Guy’s Hospital led him to give up the Fever Hospital and concentrate his attention on the work at Guy’s. He became speedily noted for his diligent attendance in the wards, and for tracing the causes of his patients’ symptoms in the post mortem room when they unhappily arrived there. For many years he spent six hours a day in his beloved scene of investigation; and long afterwards, when private practice absorbed more of his time, he longingly looked back upon the past years of cheerful research and successful toil. His progress, well prepared for, was now rapid. In 1821 he was elected F.R.S.; in 1822 he began to lecture on Botany and Materia Medica; and in 1824 he lectured on Medicine, in conjunction at first with Dr. Cholmeley, later taking the whole course alone. Some years afterwards Dr. Addison became associated in this lectureship, and the two famous men for many years upheld and raised the fame of Guy’s by their copartnership.

Bright was not a theorist, was devoid of special doctrines and “views,” but as Dr. Wilks[1] well puts it, “he could see, and we are struck with astonishment at his powers of observation, as he photographed pictures of disease for the study of posterity.” From this Dr. Wilks infers that he did not thoroughly perceive the value of his own work, and that he attached no more importance to diseases of the kidney than to those of the liver and brain, which he also described. Dr. Wilks even regards many observations of Bright as more novel and original when they were published than those relating to the kidney, but the latter were of more value, and their greater significance was at once recognised. It should be distinctly understood that Bright was not simply a specialist in kidney disease, but a clinical physician of rare excellence, who followed his cases into the post mortem room, and carefully observed not only the changes which had taken place in the organ whose disease had caused death, but also the state of all the other organs of the body. He was one of the first, if not the first, to describe acute yellow atrophy of the liver, pigmentation of the brain in melanæmia (or pigmented blood) due to miasma, condensation of the lung in whooping-cough, unilateral convulsion without loss of consciousness in local brain diseases, the bruit of the heart in chorea, the small echinococci on the interior of hydatid cysts, &c.

It is strange indeed that dropsy should have existed so long and its cause have been undiscovered; and that renal disease, as we now understand it, should have been almost unknown. For more than a century before Bright’s work was published the occurrence of albumen in the urine of dropsical persons had been known; and cases had been noted where convulsions and blood-poisoning had occurred when the kidneys had been found small and granular after death. Dr. Blackhall had written a treatise on dropsy in 1813; but though he found the urine albuminous, he rarely went to the post mortem room and examined the kidneys, which indeed might often at that time remain untouched. But until Bright’s first quarto volume of “Reports of Medical Cases,” 1827, appeared, renal disease had not been recognised as an important malady; he was at once hailed as a discoverer, and the malady called after his name. He first showed how to recognise a common form of disease, and systematised what was known about it, and he further demonstrated that there were three or four varieties of it, a view which subsequent investigation has most fully confirmed and developed in most important directions. He proved that not only was there a continual withdrawal from the blood of most important albuminous constituents, but that this was frequently attended with a failure to remove by the kidneys that natural product of waste, namely urea, which remaining in the blood in excess became poisonous, and often produced convulsions and inflammations at a distance from the kidneys. This latter view of the consequences of retained secretion was not adopted without considerable opposition, but fuller inquiry only made its truth more evident. And the adoption of a new truth had its reflex effects in other departments of investigation. Diseases of other excretory organs might possibly be caused in the same way; and so the effects of diseased liver in causing retention of the bile and its circulation in the tissues became anew illuminated; and bile-poisoning and blood-poisoning were placed on a new footing.

Although a large amount of time for many years was given to the investigation of renal cases, many other departments of research were the objects of Dr. Bright’s careful attention. We have already referred to some of these. Perhaps one series of phenomena that he was as much interested in as any was the various tumours of the abdomen, and the means of diagnosing between them. He published in Guy’s Hospital Reports an extended set of monographs on these subjects, which have been published in a collected form by the New Sydenham Society. They are chiefly clinical, illustrated by well-grouped cases, observed and recorded with great care and accuracy, and abounding in important suggestions as to diagnosis and function.

The second volume of “Reports of Medical Cases” appeared, in two parts, in 1831, and contained principally narrations of cases of cerebral and spinal diseases, including paralysis, epilepsy, tetanus, hydrophobia, and hysteria, with observations on their nature and pathology. The many coloured plates in both volumes are of great excellence and authority, being executed under Dr. Bright’s own superintendence. He was afterwards associated with Dr. Addison in the production of the first volume of the “Elements of the Practice of Medicine.” The first volume of Guy’s Hospital Reports, published in 1836, contains no fewer than eight papers from Bright’s own pen. In 1832 Dr. Bright was elected a Fellow of the Royal College of Physicians, and in 1833 gave the Gulstonian lectures at the College, on the Functions of the Abdominal Viscera, with observations on the diagnostic marks of the diseases to which the viscera are subject. In 1836 he was censor, and in 1837 gave the Lumleian lectures on Disorders of the Brain.

In his early years Dr. Bright’s practice was not very extensive. He was disinclined to use any adventitious aids to popular reputation, and was content to pursue his tireless investigations. His publications on renal disease gradually attracted general attention, and the profession found him a most reliable and valuable consultant, so that in his later years he commanded a first-class practice. A few years before his death he resigned his post at Guy’s Hospital, and was made Honorary Consulting Physician. He died on the 11th December 1858, from the consequences of extensive and long-standing ossification of the aortic valves of the heart, the exit for the blood being reduced to a mere chink. He had long suffered very considerably, but was never thoroughly examined in life. However, he believed considerably in the value of medicine, and took large quantities of some kinds. He was buried at Kensal Green.

Bright is described as having had “a remarkably even temper and cheerful disposition: he was most considerate towards the failings of others, but severe in the discipline of his own mind. He was sincerely religious, both in doctrine and practice, and of so pure a mind that he never was heard to utter a sentiment or to relate an anecdote that was not fit to be heard by the merest child or the most refined female. He was an affectionate husband and an excellent father, not only taking the most lively interest in the welfare of his children, and in their pursuits, but never so happy as when he had them around him; so that half the pleasure of the long vacation was lost, unless he had as many members of his family as possible for his companions.” He married, first, the third daughter of Dr. Babington, senior; and secondly a sister of Sir William Follett, by whom he left surviving three sons, one being Dr. Bright of Cannes, and another the Rev. James Franck Bright, the well-known historian, and Master of University College, Oxford.

It is said of Bright that he was perhaps better known abroad than any other British physician of his time. The confidence reposed in him by his professional brethren was dependent largely upon the minute attention he bestowed upon every case. He always took careful notes, and often made drawings, being a good draughtsman and rather a connoisseur in etchings and engravings.

FOOTNOTES:

[1] Historical Notes on Bright’s Disease, Addison’s Disease, and Hodgkin’s Disease, in Guy’s Hospital Reports, 3d series, vol. xxii.

[CHAPTER XII.]
LISTON, SYME, LIZARS, AND THE NEWER SURGERY.

Among operating surgeons few names take higher rank than those of Liston and Syme, at one time close associates in private medical teaching at Edinburgh, at a later period jealous rivals and even antagonists, but happily again warm friends before the sudden end of the elder. Robert Liston was born on the 28th October 1794, his father being the Rev. Henry Liston, minister of Ecclesmachan, Linlithgow, whose accomplishments included a considerable acquaintance with the theory of music, and who wrote a treatise on Perfect Intonation in addition to inventing an organ calculated to produce the desired intonation. He was educated chiefly by his father up to the age of fourteen, and afterwards attended classical and mathematical lectures in Edinburgh University during two sessions, obtaining a prize for Latin composition in the second. At this period of his life he exhibited great fondness for the sea, and was only induced to give up his desire to become a sailor by a promise that if he would study medicine he should eventually be a naval surgeon if he wished. His taste for a seafaring life never forsook him; and one of the relaxations which he most enjoyed up to within a few weeks of his death, was sailing in a yacht which he kept on the Thames. He was also very fond of field-sports.

In 1810 Liston commenced medical study as the pupil of Dr. Barclay, the well-known anatomical lecturer. He soon became noted by his instructor for his zeal and untiring assiduity, and he eventually chose him as his assistant and prosector, an office he retained until 1815. It was thus that Liston acquired the foundation of his remarkable knowledge of surgical anatomy, which his later experience strengthened, and to which he added a dexterity in the use of surgical instruments, and especially the knife, which was unsurpassed in his time.

In 1815 Liston became surgeon’s clerk or house-surgeon in the Royal Infirmary of Edinburgh, in which capacity he availed himself fully of the opportunities for making post mortem examinations, which were then performed by the house-surgeons. In 1816 he went to London, and studied several months at St. George’s Hospital, and also attended some of Abernethy’s lectures. In 1817, having taken the diplomas of the College of Surgeons both in London and Edinburgh, he began practice in Edinburgh, and again assisted Dr. Barclay in his anatomical teaching. But misunderstandings arising between them, Liston left Barclay and commenced to lecture on his own account at the beginning of the session 1818-19, James Syme becoming his assistant. In 1823 Liston gave up teaching anatomy in favour of Syme, in order to devote himself entirely to surgical teaching; but Liston retained a large share of the proceeds of the anatomical lectures, as the originator and more important proprietor of the joint school. This arrangement did not last long, Syme withdrawing to Brown Square in 1824: and it appears that Liston is, at least equally with Syme, open to the charge of having displayed serious jealousy in this matter. They were unavoidably serious rivals, too nearly equals in power, and perhaps too conscious of their own individual claims, to be able to view with equanimity each other’s proceedings and advancement.

Liston had published a little book on the Surgical Anatomy of Crural Hernia (1819), and soon acquired fame by performing several brilliant operations, difficult amputations, ligatures of arteries, lithotomy, &c. At that time there were many defects in the management of the Royal Infirmary, and Liston set to work, young as he was, to agitate for their removal. Unfortunately he did not make any attempts to conciliate the managers in so doing, and his outspoken complaints were met with bitter opposition from some of the surgeons as well as managers. He entered into the spirit of controversy which Dr. Gregory had done so much to foment, and in which so much of the talent and time of Edinburgh men was then wasted. In 1821 Liston records that he was almost daily applied to by patients from the Infirmary who had failed to secure relief from the surgeons, and he was exposed to the charge of decoying patients thence. It was even demanded of him, on pain of perpetual exclusion from the surgeoncy to the Infirmary, that he should refuse his professional assistance to any person who had been a patient there. He naturally refused to comply with any such condition, nor would he absent himself from attendance on the Infirmary practice, as was also suggested. It is fair to say that Liston courted the fullest investigation of his actions, and denied that he had ever directly or indirectly insinuated to any patient of the Infirmary that the practice followed there was bad, or that he himself knew better, or had in any way tried to entice patients away. But he did complain of the tedious and often injurious delay which took place before patients were operated upon, and the unsatisfactory result of many of the operations; while he himself had undoubtedly cured many discharged as incurable, or imperfectly relieved. The young surgeon showed so vigorous a front that great efforts were made to make the most of any imprudences he committed, and to deter students from attending his classes, especially by hints that they would come off very badly before the College of Surgeons if they did. Strange that he who now maintained so bold an attack upon convention and authority, should have shown such jealousy of his former demonstrator, Syme, and have endeavoured by manner, and more than manner, to repress and depreciate a still younger man’s skill. This was but one of the many inconsistencies and difficulties that Liston’s consciousness of his own powers and his abrupt and somewhat rough manner of dealing with differences of opinion led him into. Nevertheless the scathing charges of incompetency which Liston brought against some of the surgeons then in office, and supported in detail, were sufficient to prove to the managers that Liston was no ordinary young man, but must be allowed a full field for his talents; and consequently gaining increasing fame as a lecturer on surgery, and attracting large classes of students, Liston in 1828 became one of the surgeons to the Royal Infirmary.

But Liston’s interest was insufficient to gain him the Professorship of Surgery in the University when it fell vacant, and he gladly accepted the offer of the Surgeoncy to the North London Hospital with the Professorship of Clinical Surgery in University College in 1834. His transfer to London was a striking success. He had already published, in 1833, his “Principles of Surgery,” which went through several editions. Its clearness, simplicity, and homeliness of style made it popular, and well calculated to widen his fame. Unornamental almost to a fault, and perhaps deficient in illustration, he gave much practical information, and definitely elucidated his subject. His “Practical Surgery,” published in 1837, chiefly giving the results of his own experiences, was still more popular. His brilliant talents, however, were those of an operator. It was said of him that he possessed every qualification for success in this department, great physical strength and activity, coolness, promptitude, energy, and unflinching courage, a steady hand and a quick eye, a resolution which rose with the difficulties he encountered, and rested on a just reliance on his complete knowledge of anatomy and pathology. Yet the brilliant operator was not over anxious to exhibit his talents; he was often considered remarkably cautious. His deliberation was as marked before undertaking an operation as was his fearlessness when it was undertaken. His readiness and resource under the most varied and difficult combinations of circumstances were surprising. He excelled in irregular operations in which no well established mode of procedure could be followed, but he had to depend on the decision of the moment as to the particular case. He knew exactly what he meant to do and how to do it, and this without delay or hesitation. Thus he won the reputation of being the most dexterous operator of his day.

In addition to his “Surgery” Liston published numerous valuable papers on amputation, difficult cases of aneurism, tracheotomy, lithotomy, and lithotrity. He left his impress on a very large number of operations, either devising new methods of meeting old difficulties, or improving the accepted modes of dealing with them. He invented an improved shoe for the treatment of club-foot, and was great at reducing dislocations. He once succeeded in reducing a dislocated hip-joint after the dislocation had continued no less than two years. He introduced the method of reducing dislocated phalanges, especially of the thumb, by passing the ring of a door-key over the part and hitching it against the projecting end of the bone, so that extension and pressure could be brought to bear simultaneously. After dislocation of the thigh backwards, he several times took advantage of the immediate powerlessness of the muscles from shock, and reduced the limb on the spot without the use of pulleys or even without the aid of an assistant. He invented or modified splints for broken limbs. His methods of performing amputations by flaps became very largely adopted. He had great success in what are known as plastic operations, such as restoring a nose by taking a flap from the upper lip. His name is scarcely more associated with amputations, however, than with lithotomy and lithotrity, to which he devoted great attention. Many of his lectures on those subjects were published in the Lancet and were widely read.

Much importance has been assigned to Liston’s personal strength as constituting a large element in his operative successes. His hand and arm, it was said, might have furnished models for a Hercules, and their power was not unfrequently shown in operations requiring great muscular exertion. But he was equally successful in those in which the most delicate manipulation was demanded. His decision and force of character were equal to the accurate control over his powerful yet adaptable muscles. He would amputate the thigh single-handed, compress the artery with the left hand, using no tourniquet, and do all the cutting and sawing with the right, with only the aid of a house-surgeon to hold the limb and tie the ligatures on the arteries. He did not need time for reflection; his actions were prompted by a kind of intuition akin to genius; he seemed to comprehend at a glance the requirements of any particular case. Yet he never gave up his habit of studying anatomy, spending as many hours as possible in actual dissection.

One of Liston’s striking exhibitions of decision and invention occurred during an amputation of the thigh by Russell, then Professor of Clinical Surgery at Edinburgh. An artery in the cut bone bled profusely, and in consequence of its bony surroundings could not be tied in the ordinary way. Liston with the amputating-knife at once cut off a chip of wood from the operating table, formed it into a cone, and drove it into the bleeding orifice, and in this way immediately arrested the bleeding.[2]

Liston’s general principles of treatment are also worthy of note, as he exercised by their means a considerable influence on the profession. He early became alive to the unwisdom of over-treatment, and tended more and more to trust to natural recuperative powers. He was thus enabled to dispense with the multitudinous paraphernalia which surrounded the operating surgeon, the repeated poulticing, strapping, bandaging, anointing, which often rendered a stay in a surgical ward almost intolerable.

On the death of Sir Anthony Carlisle in 1840, Liston was elected to the Council of the Royal College of Surgeons, but did not become one of the Examiners until March 1846. There is little doubt that he would before long have attained the Presidency of the College, had not his career been cut short. His practice became very large, and there is no doubt that he undertook an amount of work which many men would have found impossible. Yet he was noted for his consideration of the poor and necessitous. It was remarked in the Times after his death that “his nature abhorred everything sordid, and no man ever was more strongly impressed with the feelings of an honourable, generous, and independent practitioner. In whatever rank of life the ‘case’ occurred, if it was one of difficulty or interest, this master of his art was ready with the potent spell of his unerring bistoury, and his reward was in the consciousness of his own power, and in the noble pride of having been ministrant to the relief of suffering humanity. His manner in ordinary society was sometimes complained of as harsh or abrupt, and he certainly was occasionally neglectful of the mere trifling courtesies of life, and sometimes careless of refinement or punctilio. He was a man of thought more than of show. He could not bear triflers, and he did not always avoid showing his distaste. He was a fervid lover of truth and sincerity, and sometimes, perhaps, expressed himself too strongly when he thought there lurked any meanness or deceit or affectation. But in the proper and trying scene of the labours of the medical man—in the chamber of the sick—he was gentle as he was resolute. He never had a patient who was not anxious to become a friend, and the voice which was sometimes discordant amid the petty annoyances of daily life was music to the sick man’s ear. Into the scene of suffering he never brought a harsh word or an unkind look, and the hand which was hard as iron and true as steel in the theatre of operation was soft as thistle-down to the throbbing pulse and aching brow. It may also be added, with perfect truth, that in the exercise of his arduous duties, among persons of the highest rank and most fastidious sympathies, his delicacy and forbearance were as remarkable as the sound sense which regulated all his professional conduct. His heart was in his business.”

Liston was warm in his friendships though strong in his dislikes. He did not readily take to strangers. It is to be noted that he became frankly reconciled to Syme after their serious divergence. He took the initiative finally in 1839, and a genial correspondence took place between them. They met once more in the autumn of 1847, when Liston visited Edinburgh, and were often together. Liston dined with Syme at Millbank the day after his arrival in Edinburgh, and again the day before he left for London. Before very long, however, Liston was carried off by aneurism of the aorta, which must have existed for years, and been fostered by his great physical exertions, which characterised his recreation as well as his work. It had been found impossible to diagnose his ailment with certainty till some little time before his death, which came with startling suddenness upon the medical world and the public generally. He died on December 7, 1847, aged 53, and was buried at Highgate Cemetery. A body of 400 students and a large number of medical men attended his funeral. He left a widow and a family of six children, two of whom were sons. One of these, however, died very soon after his father. In the following May Lord Brougham delivered a glowing eulogy on Liston at the distribution of prizes at University College. A sum of about £700 was subscribed for a memorial, which took the form of a marble statue—placed in the College—and a gold medal called the Liston Medal, which is awarded annually for surgery at the same institution.

James Syme, another of the great Scotch surgeons of this century, was born in Edinburgh on the 7th November 1799. His father, a Writer to the Signet, was of good family, but owing to unsuccessful speculations was involved in difficulties, and left nothing behind him. Young Syme was educated at the High School of Edinburgh, and soon showed characteristic patience and perseverance without brilliant parts. A certain thickness of speech, almost amounting to an impediment, strengthened the impression of shyness that he gave. Instead of country sports, he was fond of botanising, and of making skeletons of small animals. A similar tendency manifested itself in his attachment to chemistry and his fondness for making chemical experiments. Thus he was equipped with a sufficient bent towards studies connected with medicine to render it not surprising when he adopted the medical profession.

From 1815 onward Syme attended the University of Edinburgh, taking both Arts and Science lectures at first. Incidentally, in the course of his chemical pursuits, he made an original discovery of the waterproofing process, and having first dissolved indiarubber, was able to construct flexible tubes of it, and to render various substances waterproof by brushing a thin solution of it into their interstices. Not to be diverted from his medical work, Syme declined to take out a patent, but published his method. Mr. Mackintosh of Glasgow soon after patented a process, and Syme gained no advantage from his discovery.

Syme’s early friendship with Liston led him to enter Barclay’s Extra-Academical classes in the winter of 1817-18. In the next winter, however, Syme followed Liston when he started on his own account, and assisted him in demonstrating from the beginning. He perseveringly continued studying, and in 1822 went to Paris to improve himself both in anatomy and operative surgery, gaining especial advantage from Lisfranc’s and from Dupuytren’s operations and instructions.

While demonstrating for Liston, Syme was pursuing his medical studies at the Royal Infirmary and elsewhere, and became impressed with the unwisdom of the repeated and severe blood-letting then in vogue. In 1823, having become a qualified surgeon, and entering into practice in Edinburgh, Syme performed his first striking operation—one which he himself designated as “the greatest and bloodiest in surgery”—namely, amputation at the hip-joint. Its success was an earnest of his future triumphs. In the same year Liston retired from teaching anatomy to devote himself entirely to surgery, and Syme occupied his place. The summer of 1824 was spent in studying surgery as practised in Germany. The same year a coldness which had been growing between Liston and Syme caused the withdrawal of the latter from association with Liston, and his starting a new school in Brown Square in partnership with Dr. Mackintosh. Here Syme taught anatomy and surgery, Dr. Mackintosh medicine and midwifery, and Dr. Fletcher physiology. The class in surgery numbered as many as fifty students. But the difficulties and scandals attending the due supply of subjects for dissection gradually disgusted Syme with the anatomical part of his work, and a quarrel with Dr. Mackintosh finally led to his quitting the Brown Square school, and devoting himself entirely to surgery. This was a bold stroke, seeing that he had four or five formidable competitors in Edinburgh, including Liston, Lizars, and Fergusson (afterwards Sir William). Yet so strikingly was he justified by the event, that in 1828-9 his class increased to 250, the largest ever assembled by any teacher of pure surgery in Edinburgh. Practice had been flowing in upon him, stimulated in 1826 by an important paper on the treatment of wounds, in which he insisted on the importance of providing a free outlet for all discharges instead of almost hermetically sealing them up, as was so frequently done. In 1827 he gave another evidence of his remarkable operative skill by successfully removing a huge tumour involving part of the lower-jaw bone, an operation which no other surgeon would undertake. Sixteen years afterwards the patient was met with, having his deformity well covered by a vigorous beard.

It was natural that the lack of a hospital appointment should be keenly felt by Mr. Syme, and that he should apply for one when a vacancy occurred at the Royal Infirmary; but his action when this was refused to him, in view of the rivalry existing between himself and Liston, was eminently energetic and commendable. He started a small hospital for twenty-four patients at Minto House on his own responsibility; but although he fortified himself with an influential committee and received a certain amount of annual subscriptions, the principal part of the expense throughout fell upon himself. Thus in the first year the public subscribed £217 and Mr. Syme £779, including £400 which he received in students’ fees. About this time, too, he married a sister of his old schoolfellow Robert Willis, afterwards the biographer of Sydenham, and set up a carriage. These expenses led him into pecuniary difficulties, which were not easily surmounted at first, but in a few years his circumstances became easy through the rapid increase of his practice.

Syme’s clinical lectures became remarkable from the novelty of the method he employed. It had been customary in Edinburgh to lecture on a certain number of cases somewhat resembling each other, without the patients’ presence or anything to emphasise the instruction. The young innovator brought the patients one by one into the lecture-room, questioned them, demonstrated the principal features of their complaint, and then explained the principle of his treatment, in the presence or absence of the patient, according to circumstances, and finally operated, when necessary, in the presence of the pupils. Syme was a man of few words and earnest manner; he illustrated his remarks by few but well-chosen personal experiences, but gave nothing superfluous; and it is not to be wondered at that his success was marked.

Liston’s jealousy increased as the success of Minto House became assured. In 1830 Liston wrote in the subscription book of his rival’s hospital, “Don’t support quackery and humbug.” This led Syme to bring an action for libel against Liston, which the latter had to settle by apologising. In 1831, however, his exertions were successful in gaining the professorship of surgery at the Edinburgh College of Surgeons for his friend Lizars by a majority of one vote over Syme. In 1832, when Liston’s practical treatise “The Elements of Surgery” appeared, Syme also came forward with his more theoretical “Principles of Surgery.” In 1833 Syme took advantage of a chance which he longed for, and agreed with the retiring professor of clinical surgery in the University (Russell) to allow him £300 a year for life if he became his successor. This was after Liston had refused to come to any such arrangement. When it was carried into effect in 1833 the managers of the Infirmary felt that they must allow the new clinical professor to have wards for clinical teaching, notwithstanding Liston’s active opposition.

Syme’s success as a teacher followed him to the Infirmary, and pupils crowded his wards. He was regularly present when Liston operated, but never took any part with him. Syme’s appearance often, it is said, excited the evident scorn of Liston, though no open hostilities took place. The strained condition of affairs was alleviated by the removal of Liston to London in 1835. It is satisfactory to find that the quarrel was finally healed in 1839, when Liston wrote to Syme, “Will you allow me to send you a copy of my last book? Write and tell me that you wish to have our grievances and sores not plastered up, but firmly cicatrised.” A genial correspondence followed.

We wish it could be said of Syme that all his disputes were as happily concluded. His intimate friend Dr. Belfrage, minister of Slateford, whom he consulted in all his difficulties, told him “he was always right in the matter, but often wrong in the manner, of his quarrels;” and this must be held to account in part for the number and seriousness of the controversies in which he became involved, few of which, however, need be referred to here. It may be questioned whether, on numerous occasions when Mr. Syme defended himself against attacks or brought actions for damages, he would not have done better to content himself with appealing to his well-known character and attainments, and living down aspersions. But Gregory and others in Edinburgh had left an evil habit of controversy in the air; and though Syme was more moderate than his predecessors, he often had his hands full. Although he was himself a great improver of professional practice, he was really a conservative in his attitude towards other men and new methods. His opposition to Simpson’s discovery of anæsthetics, and to his introduction of acupressure for closing cut blood-vessels without the use of a ligature, is an example of this. It is to be noted, however, that Syme’s numerous controversies left no detrimental impression on the public, and did not detract from the warmth of affection which a host of friends testified towards him.

Liston’s removal to London left Syme practically in possession of the leading surgical practice in Scotland at the age of thirty-five. So marked was his progress that soon after the Queen’s accession he was appointed Surgeon in Ordinary to the Queen for Scotland. A little later a considerable fortune was left him by an uncle, and thenceforward he enjoyed an ease of circumstances which, while it rendered his actions independent, was not at all detrimental to his professional success. The good work which, in addition to operative successes, he was accomplishing may be judged by the titles of the papers contained in a selection from his published writings, published in 1848. These “Contributions to the Pathology and Practice of Surgery” included, among others, papers on senile gangrene, on the power of periosteum to form new bone, on ulcers of the leg, on amputation at the ankle-joint, on the treatment of popliteal aneurism, on excision of the ankle-joint, on the contractile or irritable stricture of the urethra, and on lithotomy. In all these he introduced new modes of treatment or operation or propounded new views, and many of his improvements are generally adopted. In 1847 Liston’s sudden death led to his chair at University College, London, being offered to Syme. After anxious weighing of the question he decided to accept the post. On his quitting Edinburgh he was entertained at dinner by more than a hundred members of the medical profession. Dr. (afterwards Sir Robert) Christison, who presided, said no man had ever obtained so early in life as Syme the position of consulting surgeon for a whole nation; and this he owed entirely to his intrinsic merits. He referred to the collateral pursuits with which many doctors had recreated themselves. Dr. Cullen had his rural retreat; Dr. Gregory his Latin and polemics; Sir Charles Bell his pencil and his rod; Mr. Liston his hunter; Mr. John Bell his trombone. Mr. Syme had rendered his garden and conservatories conspicuous in a land of gardeners.

Mr. Syme arrived in London in February 1848, and settled in Bruton Street. An amusing incident occurred in connection with his first lecture at University College. Having been accustomed to give clinical lectures in the operating theatre at Edinburgh, which was provided with seats, he supposed a similar arrangement obtained in London, and announced his intention of lecturing in the operating theatre without having previously visited it. On entering the room to deliver his lecture, he found the students were seated inelegantly on the rails which rise behind one another in the amphitheatre. This attitude shocked him at first, but was soon exchanged for a more befitting one.

Difficulties, however, arose in connection with the chair of systematic surgery, which he was asked to undertake with that of clinical surgery. This he felt would occupy too much time, and require a devotion to theoretical surgery and to pathology which did not accord with his bent. On the 7th of May some discourteous demonstrations at the College prize distribution towards two of his colleagues deeply wounded him; and he wrote “that the slightest approach to any insult of the kind, whether offered in the comparative retirement of the lecture-room or inflicted publicly with the silent sanction of the presiding authority of the College (Lord Brougham), would effectually incapacitate him from ever addressing his pupils with satisfaction to himself or benefit to them.” In three days afterwards, having declined the fresh post offered him, he resigned that for which he had quitted Edinburgh. Fortunately his old position at Edinburgh had not yet been filled up, and he returned with alacrity to his familiar theatre and beloved home, his experiment having cost him £2000. He had been well received by the heads of the profession in London, and was rapidly gaining practice. His own brief comment on the change from Edinburgh to London was, that ambition made him sacrifice happiness, and that he found such a spirit of dispeace in University College as to forbid any reasonable prospect of comfort.

The succeeding years furnish a multitude of records of honours paid to Professor Syme, and of distinguished successes in operating. In 1848-9 he was elected president of the Medico-Chirurgical Society of Edinburgh, and greatly elevated the character of its proceedings; in 1850-1 he was president of the Edinburgh College of Surgeons. For years few numbers of the Monthly Medical Journal appeared without a lecture, case, or observation of importance from him. One of his most striking operations was the removal of the entire upper-jaw bone by making one incision in the cheek, with perfect success; the wound healed without a drop of matter, and it was difficult subsequently to trace the line of incision. The patient’s articulation remained quite distinct. Two of his most difficult operations in 1857 were connected with the tying of arteries for cure of aneurisms—one of the carotid, the other of the iliac, artery. The frightful risks and the excellent procedure by which they were successfully encountered still further enhanced Mr. Syme’s great reputation. In 1856-7 his “Principles of Surgery” reached a fourth edition. Its terse style and clear exposition had rendered it a great favourite with practical surgeons. A striking feature in it is the constant reference to fundamental principles. It was said of him at this period, “Mr. Syme is never at fault. Something unforeseen or unexpected may occur, but its import is at once understood and the contingency provided for.”

At the Great Exhibition of 1862 Syme was chosen chairman of the jury on surgical instruments. In 1863 he visited Dublin once more, and expounded his principles before the leading surgeons, being received there as a man of European reputation. His operations for the relief of axillary and carotid aneurisms, as well as his bold excision of the whole scapula for tumour, with safety and without much loss of blood, were continually increasing his fame. In 1864 he published his work on the Excision of the Scapula, and proved that the wound might heal quickly and soundly, and the arm remain strong and useful. A great operation for relief of a distressing disease by excision of a large part of the tongue was wonderfully successful in November 1864. This was the last case Syme had time to publish. In August 1865 he gave the address in surgery at the meeting of the British Medical Association in Leamington. In it he gave a graphic account of modern improvements in surgery, in which he had himself a large share, and contrasted it with the state of things at the beginning of his professional career. It constituted a most valuable review of the history of surgery during the century. Syme was the first representative at the Medical Council of the Universities of Edinburgh and Aberdeen, and might not improbably have been its president but for his illness and death. His last great controversy was that known at Edinburgh as the “Battle of the Sites.” A new hospital was required, and at first, in 1866, Syme was strongly in favour of a new building on the old site. But further experience of erysipelas and pyæmia in the old hospital convinced him of the necessity of having an entirely new building in which the old disadvantages would be absent. He consequently changed his view, and strongly advocated the new plan, which was ultimately, in 1869, accepted. But he did not live to see the new work begun.

In private life Syme was genial and happy, throwing off all professional cares, quarrels, and anxieties in the home circle. His unobtrusive religion was an essential feature of his character. He was devoted to truth and earnest in its advocacy, and hence sprang many of his controversies; but he had no love for controversy as such. His domestic life was very happy, though broken at various times by death. His first wife died in 1846: of her numerous family two daughters only survived to adult age, one of them being now the wife of Sir Joseph Lister. His second wife was the sister of Burn, the architect: this union was equally happy with the former; but the second Mrs. Syme also died before him. Her youngest child was Mr. James Syme, the present proprietor of Millbank. This house and estate Professor Syme decorated and improved with all that horticulture and excellent taste could devise, and it was under his sway one of the most charming resorts near Edinburgh. His social gatherings of eight, ten, or twelve choice spirits were delightful, and his hospitality was both large and discriminating.

It is pleasing to record that Mr. Syme welcomed the greatest surgical improvement of modern times, that brought forward by Professor Lister, his son-in-law. In 1868 he contributed a valuable paper to the British Medical Journal “On the Antiseptic Method of Treatment in Surgery,” by which he greatly aided its progress. This was his last year of full practice. In April 1869 he was seized with paralysis, resigned his professorship and surgeoncy soon after, but recovered sufficiently in the autumn to receive a testimonial in St. James’s Hall, London (November 10, 1869), at a public dinner in which the leaders of the profession vied with one another in honouring him. The testimonial took the form of the endowment of a surgical fellowship in the University of Edinburgh, in addition to the placing of a marble bust in the Infirmary or University library. A bust was subsequently placed in both of these situations. Syme at length died, after repeated attacks of paralysis, on the 20th of June 1870.

It has been well said by Professor Goodsir, that few men come to their principles at such an early age as Mr. Syme. His terseness of writing aided greatly in their propagation, and his practice was extended far and wide by the assurance that “he never wasted a word, nor a drop of ink, nor a drop of blood.” He was great too in his conservation of all parts which might by any dexterity and patience be made useful. His revival of operations for the excision of joints rather than the amputation of limbs is an instance of this. Syme’s operation of amputation at the ankle-joint will always remain in vogue as the least fatal and most useful in surgery.

Professor Lister has thus summed up Syme’s character as a surgeon—“A practical surgeon, Mr. Syme presented a remarkable combination of qualities; and we have not known whether to admire most the soundness of his pathological knowledge, his skill in diagnosis, resembling intuition, though in reality the result of acute and accurate observation and laborious experience, well stored and methodised; the rapidity and soundness of his judgment, his fertility in resources as an operator, combined with simplicity of the means employed, his skill and celerity of execution, his fearless courage, or the singleness of purpose with which all his proceedings were directed to the good of his patients.”

Though his fame has been overshadowed by the greater distinction of Liston and Syme, John Lizars deserves mention, not only as a brilliant operator, but also as a teacher, lecturer, and author. He was fortunate in his instructor, having been the pupil and apprentice of John Bell. After obtaining his qualification in 1808 Lizars became a naval surgeon, and saw good service on the Spanish and Portuguese coasts in Lord Exmouth’s fleet. He left the navy in 1815, and settled in Edinburgh, joining Allan, who lectured on surgery, and taking himself the departments of anatomy and surgery. Later, when this partnership was dissolved, Lizars continued to lecture, adding surgery before long to his programme, and hence being almost incessantly engaged during the prolonged winter session with his daily lectures on each subject. His zeal and method attracted, and retained for years, classes frequently numbering one hundred and fifty. He was obliged after a time to limit his labours when the Edinburgh College of Surgeons decided to recognise lectures in one department only from any given lecturer; and he resigned his anatomical lectures to his brother Alexander, afterwards Professor of Anatomy in the University of Edinburgh, and thenceforward lectured on surgery alone. In 1831 John Lizars was appointed Professor of Surgery to the College of Surgeons, a post which he held for eight years. He had previously become surgeon in the Infirmary, and was considerably senior to Liston. The two were not unworthy compeers as regarded brilliancy in operating. Lizars’ ease and coolness under circumstances of difficulty were remarkable. He is said to have been the first who performed the operation for the removal of the lower jaw.

Lizars published a “System of Practical Surgery”; but is perhaps best known for his great folio series of coloured “Anatomical Plates” with companion (octavo) volume of text. The engravings of the plates were for the most part made from original dissections by himself. They formed an immense series of illustrations, occupying 110 folio plates, and some of them, especially those on the brain and nervous system, can scarcely be surpassed for artistic excellence. It was really a magnificent work for its day, and had a very large sale; and as regards a great portion of the contents, since they show actual facts, they cannot be superseded. After his retirement from teaching, Lizars devoted himself to private practice, both surgical and general. He died at Edinburgh, May 21, 1860.

FOOTNOTES:

[2] The writer is indebted for this anecdote to Dr. Paterson’s “Memorials of the Life of James Syme,” in which a number of incidents relating to Liston are given, with an interesting parallel between the careers of the two great surgeons (chapter xii., p. [210-216]). It is much to be regretted that no biography of Robert Liston has yet been written.

[CHAPTER XIII.]
BAILLIE, HALFORD, CHAMBERS, AND HOLLAND, THE FASHIONABLE AND COURTLY PHYSICIANS.

One cannot more strikingly emphasise the change which has taken place during the present century in the views and practice of medical men than by quoting from Sir Henry Halford’s biographical notice of Baillie, the nephew of William and John Hunter, and brother of Joanna Baillie. Here we have Halford acknowledging a current sentiment against physical examination of the patient. “He (Baillie) appeared to lay a great stress upon the information which he might derive from the external examination of his patient, and to be much influenced in the formation of his opinion of the nature of the complaint by this practice. He had originally adopted this habit from the peculiar turn of his early studies,—and assuredly such a method, not indiscriminately but judiciously employed, as he employed it, is a valuable auxiliary to the other ordinary means used by a physician, of obtaining the knowledge of a disease submitted to him. But it is equally true that, notwithstanding its air of mechanical precision, such examination is not to be depended upon beyond a certain point. Great disordered action may prevail in a part without having yet produced such disorganisation as may be sensibly felt; and to doubt of the existence of a disease because it is not discoverable to the touch, is not only unphilosophical, but must surely, in many instances, lead to unfounded and erroneous conclusions. One of the inevitable consequences of such a system is frequent disappointment in foretelling the issue of the malady, that most important of all points to the reputation of a physician, and though such a mode of investigation might not prove unsuccessful in the skilful hands of Dr. Baillie, it must be allowed to be an example of dangerous tendency to those who have not had his means of acquiring knowledge, nor enjoyed the advantages of his great experience, nor have learned by the previous steps of education and good discipline to reason and judge correctly.” Halford then refers to the quickness with which a good physician makes up his mind on the nature of a disease; at that time it was oftener a guess than a process of reasoning. Baillie was one of the first to study pathology, and to bring into practice physical examination.

Matthew Baillie was born on the 27th October 1761, in the manse of Shotts, Lanarkshire, his father having been Professor of Divinity in Glasgow University, his mother, Dorothea, sister of William and John Hunter. After two sessions at Glasgow, Baillie entered, in 1779, at Balliol College, Oxford, where he completed his M.D. in 1789. Residing during vacations with William Hunter, he became almost like a son to him, and assisted him much in making his anatomical preparations and superintending his dissecting-room. On the death of his uncle in 1783, he and Cruickshank continued the lectures with great success. Baillie lectured till 1799. One of his pupils said of him that his style, though not eloquent, irresistibly commanded attention; he appeared completely master of his subject, was exceedingly clear, concise, and condensed, and never at a loss for an appropriate word. He was always modest and unostentatious. When left sole heir of his uncle William, he at once transferred to John Hunter the family estate of Long Calderwood, to which he regarded him as entitled.

Baillie’s principal work is pathological. In 1793 he published “The Morbid Anatomy of some of the most Important Parts of the Human Body,” and although pathology is now very different from what it was in his day, and his classification is not now useful, his facts, when properly interpreted, are still found excellent. The work met with very great success, and was translated into many European languages, besides going through five English editions in the author’s lifetime.

Baillie gradually got into good practice, being appointed physician to St. George’s Hospital in 1787, elected Fellow of the College of Physicians in 1790, Censor in 1791 and 1796, and Fellow of the Royal Society in 1789. On the retirement of Dr. Pitcairn from practice in 1798, Baillie succeeded to a great part of it, and his practice was still further benefited by his marriage with the daughter of Dr. Denman, whose great obstetric practice enabled him to recommend Baillie very frequently. He resigned his hospital work in 1799, and from that time had perhaps the leading practice in London, making ten thousand pounds in some years. He was consulted about George III.’s case, and in 1810 was made Physician to the King and offered a baronetcy, which he declined. In 1814 he was also appointed Physician-in-Ordinary to the Princess Charlotte, and attended many members of the royal family. His manner towards his fellow-practitioners was as pleasing as his conduct to patients. To both he would carefully explain, as far as possible, his views of the nature of the case and the treatment required, and he was exceedingly successful in tranquillising the apprehensions of his patients. His modesty was transparent. He would say to his friends: “I know better perhaps than another man, from my knowledge of anatomy, how to discover a disease, but when I have done so, I do not know better how to cure it.” From this one is not surprised to learn that he was not fertile in expedients, but if the simplest means failed, he was often at a loss what to do next, and was not apt at varying his prescriptions.

Baillie was not without an irritability of temper, in which we see some resemblance to John Hunter; but his heart was at bottom most kindly. He would often say after an outbreak, “I have spoken roughly to that poor man; I must go and see him, be it ever so late;” “that patient is in better health than I am myself, but I have been too hard with him, I must make him amends.” There were many instances of his great and delicate generosity to his patients. Overwork, to the extent of devoting sixteen hours a day to practice, enfeebled his constitution, and before the age of sixty he was compelled to retire in a large measure from practice. He died at his seat, Duntisbourne House, near Cirencester, on the 23d September 1823, leaving a fortune of £80,000. He bequeathed a considerable sum to the College of Physicians, with his manuscripts and other interesting curiosities, such as the gold-headed cane used by Radcliffe, Mead, and others, whose arms are engraved on it. He was buried in Duntisbourne Church, but his memory was commemorated by his professional friends by a fine bust by Chantrey in Westminster Abbey. His excellent qualities and his strong religious principle were well set forth by Sir Henry Halford in an address to the College of Physicians.

Sir Henry Halford was long a contemporary of Baillie, but survived him more than twenty years. He was the second son of Dr. James Vaughan, a successful physician at Leicester, whose third son became a judge of the Court of Common Pleas; the fourth son was Dean of Chester and Warden of Merton College, Oxford; the fifth, Envoy-extraordinary to the United States; and the sixth was the father of Dean Vaughan, the well-known Master of the Temple. The eldest son died in his twenty-third year. The distinction which Vaughan’s sons attained shows that his judgment was admirably exercised in their education. In fact, he spent his whole professional income in providing for them the best possible educational aids. Henry, like the others, was sent from Rugby to Oxford (the youngest only going to Cambridge); and he records, in eulogising his father’s treatment of them, that not one of them asked or received further pecuniary assistance from him after he had finished his education, and commenced his own efforts to provide for himself.

Henry Vaughan was born on October 2d, 1766. Entering at Christchurch, Oxford, he graduated B.A. in 1788, M.D. 1791. He studied medicine for some months at Edinburgh, and also practised for a time with his father at Leicester. About 1792 he came to London, and having a good opening through his Oxford friends, had courage enough to borrow £1000 on his own security in order to establish himself in London practice. Here his good manners and evident learning stood him in good stead, and he was elected physician to the Middlesex Hospital in 1793, becoming a Fellow of the College of Physicians in 1794. In March 1795 he still further promoted his advancement by his marriage with the third daughter of Lord St. John, and rapidly rose into note. With all his talents, however, it looks like one of fortune’s freaks that Vaughan should have been appointed Physician-Extraordinary to the King in 1793, at the age of twenty-seven; and that his practice should have so increased that in 1800 he was compelled to give up his hospital appointment. But fortune had more favours in store for him. He inherited a large property on the death of Lady Denbigh, widow of his mother’s cousin, Sir Charles Halford; and he consequently changed his name in 1809 by Act of Parliament from Vaughan to Halford. George III. created him a baronet in the same year.

The King had indeed a strong preference for Sir Henry Halford, as he now became. He secured Sir Henry’s promise, before the onset of his last long derangement, that he would not leave him, and that if necessary he would call in also Dr. Heberden and Dr. Baillie. To recite the number of royal personages to whom Sir Henry was physician would be tedious; suffice it to mention that he attended, besides George III., George IV., William IV., and Queen Victoria, having thus been the physician of four English sovereigns.

There is no doubt that Halford possessed talents of a high order. He is said to have been inferior to Baillie in accuracy of diagnosis, but superior in the cure and alleviation of disease. He had quick perception, sound judgment, and great knowledge of the powers of medicines. For many years after Baillie’s illness and death he was undisputedly at the head of London practice. At the College of Physicians his rule continued unchecked, if not unquestioned, for more than twenty years, he having been President from 1820 till his death on the 9th of March 1844. He was largely instrumental in securing the removal of the College from Warwick Lane in the city to the present commodious building in Pall Mall East. His bust by Chantrey was presented to the College by a number of Fellows. His portrait by Sir Thomas Lawrence is at Wistow, Leicestershire, where he was buried in the parish church.

Halford’s early success was not favourable to his prosecuting original research nor to his publishing much that is important. His chief publications were first given as addresses to meetings of the College of Physicians. In these he showed skill and pleasing literary art. He wrote on the Climacteric Disease, on the Necessity of Caution in the Estimation of Symptoms in the Last Stages of some Diseases, on the Tic Douloureux, on Shakespeare’s Test of Insanity (Hamlet, Act iii. Sc. 4), on the Influence of some of the Diseases of the Body on the Mind, on Gout, on Phlegmasia Dolens, on the Treatment of Insanity, and on the Deaths of some Illustrious Persons of Antiquity—and again, on the Deaths of some Eminent Persons of Modern Times. It is to be regretted perhaps that a man of such accomplishments should have left so little behind him; but he was of use to his day and generation; and as to the knowledge he had attained, it served him only to affix the term “conjectural” to medicine, when speaking of the confidence Baillie inspired. At least he did not seem to have hidden from himself how little the medicine of his days could lay claim to being completely informed.

William Fredric Chambers, the son of an East Indian civil servant, whose family belonged to Northumberland, was born in India in 1786. Brought to England in 1793 in consequence of his father’s death, he was educated at Bath, Westminster, and Trinity College, Cambridge, where he graduated B.A. in 1808. He had hoped for a fellowship, intending to take orders; but being disappointed, he turned to medicine, and entered at the Great Windmill Street School, subsequently spending a year at Edinburgh, and returning to study at St. George’s Hospital, the Eye Infirmary at Moorfields, and at Bateman’s celebrated Dispensary. His diligence, both in practical medical study and in dissections, attracted the attention of the St. George’s physicians, and on the resignation of Dr. Pelham Warren, then one of the leaders of London practice, he was brought forward and elected physician to the Hospital in 1816 when only thirty years of age. His East Indian connection secured him, in 1819, the post of examining physician to the East India Company, after being some time assistant-physician. Notwithstanding his early prominence, his professional income rose but slowly, showing that neither ability nor patronage will avail greatly in competition with the established favourites. It was 1825 before Chambers’s practice amounted to £2000; and his pre-eminence was not marked till the death of Dr. Maton in 1835, and the great age of Sir Henry Halford (who died in 1844), left him in indisputed possession of the leading London practice. From 1836 to about 1851 he received in fees between seven and nine thousand guineas a year. In 1836 he was consulted by Queen Adelaide, and in 1837 was made Physician-in-Ordinary to William IV., declining knighthood, though made Commander of the Guelphic order. He was continued as Physician-in-Ordinary to Queen Victoria, and his successful career was uninterrupted, except by rather frequent ill-health. About 1851, owing to the failure of his health, he retired from practice, and settled near Lymington, where he died on the 17th December 1855.

Chambers did not win his success either by writing, teaching, or discovering. In addition to a tall commanding figure, and the most agreeable, yet straightforward manners, he possessed striking decision, and pursued bold and successful plans of treatment in acute diseases. He kept himself well acquainted with the advances of others, and was early distinguished by his adopting the stethoscope. Like many men of great eminence, he was at heart exceedingly diffident, and felt acutely the responsibilities which he undertook. He was continually in fear of doing something wrong or making a mistake. Thus he undoubtedly was a most conscientious physician, and it is to be feared that he gave himself much suffering by the minutely painstaking system that he adopted. Both at the hospital and in private practice, he personally recorded the particulars of every case that he saw, together with all his prescriptions—an astounding instance of laborious effort. In this way his private practice furnished sixty-seven large quarto volumes of notes, which were every day completely written up, and carefully indexed, so that he could refer with the utmost ease to any case he had ever seen. Moreover, he made in very many instances sketch maps of the diseased organs, side by side with the description. So persistent was he in this conscientious toil, that he often continued it far into the night and even till daylight, resuming work again before nine o’clock. Ill-health was a necessary consequence, but his reliability was certain to tell in practice. He could scarcely depend on a single regular meal a day, so great was the demand for his services. He literally rushed through the streets driven post-haste at ten miles an hour. After a serious illness in 1834, through having absorbed poisonous matter from a patient who had died of pleurisy, his right hand was distorted by the results of abscesses; and it was hence vulgarly reported that his fingers had become crooked from the continual habit of taking fees. The regard he won from others may be evidenced by the fact that Sir Benjamin Brodie for some weeks visited him daily during this illness at Tunbridge Wells, when this entailed much greater loss of time than now. His liberality was well known, and this, with his frequent illnesses, caused him to accumulate no great fortune.

With regard to Sir Henry Holland, it is with regret that we own how comparatively slight are his claims to a place in the gallery of great medical men. He was accomplished beyond most men, but one is compelled to ask, what did he accomplish with his great opportunities? Whom did he teach? what did he teach? what did he discover? His travelling excursions extended over almost the whole globe except Australia. He was intimate for more than half a century with many men and women of mark on both Continents. He knew well the Presidents and statesmen of the United States; prescribed for six Prime Ministers of England, as well as for its sovereigns and princes. But even in regard to information of moment which he might justifiably have given concerning them, he has been strikingly reticent in his “Recollections of Past Life.”

Henry Holland, the son of Peter Holland, a much-respected medical practitioner, was born at Knutsford in Cheshire, on October 27, 1788. His maternal grandmother was a sister of Josiah Wedgwood, the eminent potter, and grandfather of Charles Darwin. Holland was also a cousin of Mrs. Gaskell, the author of “Mary Barton,” and biographer of Charlotte Brontë. He was educated first at Newcastle-on-Tyne under the Rev. W. Turner, and early showed his predilection for travel by making long pedestrian excursions in the neighbourhood. In 1803, he went for a year to Dr. Estlin’s school, near Bristol, where he succeeded at once to the position of head boy, left vacant by John Cam Hobhouse, afterwards Lord Broughton, and where he also commenced his long friendship with Richard Bright, who has already been mentioned in this work. His classical and literary tastes here developed, and were further fostered by a vacation passed at Dr. Aikin’s at Stoke Newington, and in the society of his sister Mrs. Barbauld and his daughter Lucy Aikin. Still, young Holland leaned towards a commercial life, and entered a Liverpool merchant’s office, with the stipulation that he was to spend two sessions at Glasgow University. These saved him from being bound to a merchant’s desk; for after his second session, 1805-6, he sought and obtained release, and took up medicine. At Glasgow he had become intimate with William Hamilton (afterwards Sir William), his discussions with whom had doubtless a considerable influence on his mental development. Holland’s literary talent already began to show itself, for he was selected at the age of eighteen to draw up a Statistical Report on the Agriculture of Cheshire for Government, and received for it £200, double the sum proposed.

In October 1806, Holland entered at the Edinburgh Medical School; but he did not confine himself exclusively to one school, for he spent two succeeding winters in the Borough Schools of London, Guy’s and St. Thomas’s, and in private study. Resuming at Edinburgh, he took his degree in 1811. Travel had already found him apt; in 1810 he went to Iceland with Sir George Mackenzie and Richard Bright, and contributed considerable portions to the narrative of the expedition. Holland early became associated with the Whig section of Edinburgh society, but he saw much of its general aspects, and he knew Walter Scott, Dugald Stewart, Francis Jeffrey, Henry Erskine, and many others known to fame. He had already made the acquaintance of Maria Edgeworth during a visit to Ireland; and her letters to him would in themselves fill a volume. Everywhere the bright pleasing intelligent youth was welcomed. As he could not yet be admitted by the College of Physicians owing to his lack of years, he undertook extensive travels on the Continent, venturing into little-known regions, and published his “Travels in Portugal, Sicily, the Ionian Islands, and Greece,” in 1815, a work which yet further increased his fashionable repute. Mrs. Piozzi, writing from Bath in 1815, says, “We have had a fine Dr. Holland here. He has seen and written about the Ionian Islands, and means now to practise as a physician—exchanging the Cyclades, say we wits and wags, for the sick ladies. We made quite a lion of the man. I was invited to every house he visited at for the last three days. So I got the queue du lion, despairing of le cœur.”

Holland had spent much time in the military hospitals in Portugal during his travels, and gained valuable experience. In Turkey he came into contact with Ali Pasha, through whom he was deprived of most of his papers relating to Albania, a mortifying loss at the time. After his return home he speedily formed friendships with Lords Lansdowne, Aberdeen, and Holland, which continued uninterrupted save by death, and of course led to his intimacy with many other persons of note, traits in whose characters are recorded in the “Recollections.” We cannot here follow the incidents of the brilliant social life into which Henry Holland entered with so much zest. Suffice it to mention that he was elected to the Royal Society in 1816, and admitted on the same day as Lord Byron, who on that occasion made his only visit. Henry Holland was an almost constant guest at Holland House. In the summer of 1814 he became domestic medical attendant on the Princess (afterwards Queen) Caroline, to accompany her during her first year of travel on the Continent. This situation became one of extreme delicacy, and its importance was very manifest at her trial years afterwards, where Dr. Holland’s evidence, declaring that he had never seen anything improper or derogatory in her behaviour to Bergami or any other person, proved of extreme weight in her behalf.

A man of such connections could not fail to gain almost as much practice as he liked. His visits to Spa for four successive years, after the London season, strengthened his professional prospects, and his fourth year’s practice brought him over £1200. In a few years he was able to resolve that his professional income should never exceed £5000, and that he would give to study, recreation, or travel all his surplus time. Thus happily placed, Henry Holland became the friend of every man of note, the patron of science at the Royal Institution, of which he was long president—but not the hospital physician, the clinical teacher, the original writer, the promoter of medical reform, or the habitué of the medical societies. He dined out, and never reproved his patients for the lapses from physiological prudence which he observed at the table. The “frequent half hour of genial conversation” was what he bestowed and was most capable of bestowing on his patients. Perhaps he thereby solaced their days of tedium or hypochondria as well as others who might have sought to root up their habits or impart tone to their minds with more ruthless energy. “When Lady Palmerston was suffering from an illness that occasioned some alarm to her friends,” said the Times, in its obituary notice of Holland, “one of them, meeting the late Dr. Fergusson, asked anxiously how she was. ‘I can’t give you a better notion of her recovery,’ was the reply, ‘than by telling you that I have just received my last fee, and that she is now left entirely to Holland.’” On this being repeated to Lord Palmerston his lordship mused a little, and then said, “Ah! I see what he means. When you trust yourself to Holland, you should have a superfluous stock of health for him to work upon.” Holland himself had this superfluous stock of health. When over eighty he writes: “A frequent source of amusement to myself is my incapacity for walking slowly; and the sort of compulsion I even now feel to pass those immediately before me in the street, and to take the diagonal instead of the two sides of a square, whenever this is the alternative. When I cease to take the diagonal (often a dirty one) instead of the side pavements, I shall consider that I have gone a step downwards in the path of life.” His excursions were almost all taken alone; but he evidently seldom put himself out of the reach of general society, as good as the neighbourhood afforded. He was no recluse, yet apparently not a man of a few warm strong personal friendships. If he was we find no record of it. From his utter reticence about his medical contemporaries, we should judge that he did not at bottom appreciate them as they deserved.

To give briefly a few of the more notable dates in Holland’s life, he married first, in 1822, a Miss Caldwell, who died in 1830, leaving two sons, the present Sir Henry Holland and the Rev. F. J. Holland; and secondly, in 1834, Saba, daughter of Sydney Smith. He was made Physician-Extraordinary to the Queen in 1837; Physician-in-Ordinary to the Prince-Consort in 1840; was offered, but declined, a baronetcy by Lord Melbourne in 1841; was made Physician-in-Ordinary to the Queen in 1852, and accepted a baronetcy in 1853. In later years he withdrew altogether from practice, but continued active in society and persevering in travel. In his last journey, to Russia, he was accompanied by his son, the Rev. F. J. Holland; on his way back he attended the trial of Marshal Bazaine at Versailles on the 24th October 1873, dined the same day at the British Embassy, returned to London the next day, did not go out on Sunday the 26th, and died quietly in bed on the 27th, on the 85th anniversary of his birth.

To this extraordinary age lived the man who had been seen in all climates, in the Arctic Circle or in the Tropics, on the Prairies or the Pyramids, in the same black dress coat in which he almost ran from house to house at home. Sydney Smith said of him that he started off for two months at a time with a box of pills in one pocket and a clean shirt in the other—occasionally forgetting the shirt. Let Sir Henry tell his own tale of his enjoyment. “The Danube I have followed, with scarcely an interruption, from its assumed sources at Donau-Eschingen to the Black Sea—the Rhine, now become so familiar to common travel, from the infant stream in the Alps. The St. Lawrence I have pursued uninterruptedly for nearly two thousand miles of its lake and river course. The waters of the Upper Mississippi I have recently navigated for some hundred miles below the falls of St. Anthony. The Ohio, Susquehanna, Potomac, and Connecticut rivers I have followed far towards their sources; and the Ottawa, grand in its scenery of waterfalls, lakes, forests, and mountain gorges, for three hundred miles above Montreal. There has been pleasure to me also in touching upon some single point of a river, and watching the flow of waters which come from unknown springs or find their issue in some remote ocean or sea. I have felt this on the Nile at its time of highest inundation, in crossing the Volga when scarcely wider than the Thames at Oxford, and still more when near the sources of the streams that feed the Euphrates, south of Trebizond.” Altogether Sir Henry estimated that he had spent twelve years of his life in foreign travel.

Literary work was a pastime with Holland, and both in the Quarterly and the Edinburgh Reviews he delighted to show his extensive reading, and his enlightened yet very unrevolutionary views. His more interesting reviews have been published as “Scientific Essays,” and “Chapters on Mental Physiology;” while his “Medical Notes and Reflections” constitutes almost all his practical contribution to medical science. Interesting “Fragmentary Papers” were published posthumously. In the “Medical Notes” certain current questions were philosophically discussed in a most pleasing style, and some questions of practice treated with some originality if not with boldness. Two chapters may be especially alluded to as valuable, namely, those “On the Abuse of Purgative Medicines,” and “On Bleeding in Affections of the Brain.” Many of his chapters on Mental Physiology show wide observation and kindly insight into the relations of mind and body. But after all it is by his “Recollections of Past Life” that Holland will be most known, his sketches of the leading personages, politicians, wits, and scientific and literary men having a charming vividness and truthfulness about them, making every one regret that so many limitations were imposed by the author upon himself when he might have easily furnished so much more material for history.

Holland was of the middle height, spare in appearance, but very active; with a countenance not indicative of the highest mental power.

[CHAPTER XIV.]
SIR WILLIAM FERGUSSON AND CONSERVATIVE SURGERY.

The association of the word “conservative” with operative surgery, so strongly identified in the popular mind with the removal of portions of the body, needs some explanation to the non-professional reader. In former times inflammation with denudation of bone was commonly believed to necessitate amputation; and diseased joints, especially the elbow, knee and ankle, with ulceration of cartilages, were generally considered incurable, except by removal of the limb. As Fergusson said, the ways of surgery get grooved; they are hallowed in the estimation of some. The man who steps from the groove is held to be rash and is called to account. How much this was the case will be seen by the reception accorded to conservative surgery, which aspired to do away with many of the radical proceedings of the past.

The term “conservative surgery,” as first used by Sir W. Fergusson in 1852, meant operations for the preservation of some part of the body, which would otherwise have been unnecessarily sacrificed. A smaller and more limited operation was undertaken to remove simply the incurably disorganised portion of the body, such as a diseased joint, and not an entire limb. Thus Fergusson said, “a compromise may be made, whereby the original constitution and frame, as from the Maker’s hand, may be kept as nearly as possible in its normal state of integrity.” “No one can more thoroughly appreciate a well-performed amputation than I do, but I certainly appreciate more highly the operation which sets aside the necessity for that mutilation.”

Two great surgeons thus bear testimony to Fergusson: “The improvements which he introduced in lithotrity and in the cure of cleft-palate may almost be considered typical,” says Sir Spencer Wells,[3] “of the school of modern conservative surgery, and will long be acknowledged as triumphs of British surgery in the reign of Victoria.” He was, in the words of Sir James Paget, “the greatest master of the art, the greatest practical surgeon of our time.”

William Fergusson was born on March 20th, 1808, at Prestonpans, East Lothian, and was educated first at Lochmaben in Dumfriesshire and afterwards at the High School of Edinburgh. At fifteen he entered a lawyer’s office, by his own desire, but soon found that law did not suit him, and at seventeen exchanged law for medicine, which profession his father had wished him to adopt. He was early attracted by the teaching of Robert Knox, the celebrated anatomist, who quickly discerned the stuff his pupil was made of. Fergusson would often spend from twelve to sixteen hours a day in the dissecting-room. One of his dissections of the nerves of the face, preserved in the museum of the Edinburgh College of Surgeons, remains an admirable example of manipulative skill and dexterity, and the stand on which it is placed is also a specimen of his work. At twenty Knox made him demonstrator to his class, which then numbered four hundred. He had previously assisted John Turner, Professor of Surgery at the College of Surgeons. At the early age of twenty-one Fergusson became Fellow of the College of Surgeons by examination. Knox then promoted him to a share in his lectures on general anatomy, and the young lecturer also gave demonstrations on surgical anatomy, which proved highly valuable. He soon began to manifest his skill in operative surgery, and in 1831 he was elected surgeon to the Edinburgh Royal Dispensary, and showed his boldness by performing the important operation of tying the subclavian artery, which as yet had only been twice done in Scotland. In 1833 he married Miss Ranken, heiress of the estate of Spittlehaugh in Peeblesshire. This marriage, while it placed him beyond pecuniary difficulty, had no effect in diminishing his industry. In 1839 he became surgeon to the Royal Infirmary, and Fellow of the Royal Society of Edinburgh, and already shared the highest surgical practice with Syme. In fact there was hardly room for two such men in Edinburgh. Liston had betaken himself to London. In 1840 Fergusson followed his example, accepting an invitation to King’s College, which was now establishing its hospital. At a farewell presentation, Lizars said that he had seen no one, not even Liston himself, surpass Fergusson in the most trying and critical operations. The man of whom this could be said at the age of thirty-two had every chance of success in London, even though he came thither with scarcely any personal friends to back him. Professor Partridge, his old friend, gave him a cordial introduction, and he established himself in Dover Street, Piccadilly, only to find that his first year’s private practice did not exceed £100. Yet it cannot be denied that Fergusson came to London at a fortunate period. Within a few years death or retirement withdrew from practice many of the most capable operators, such as Liston, Aston Key, and Astley Cooper. Thus his success was really rapid, for his third year brought him £1000, and in 1847 he removed to a large house in George Street, Hanover Square. His style of operating soon attracted general attention both among students and practitioners, and King’s College operating theatre became the resort of all the medical students and practitioners who could cram into it.

As an operator Fergusson was most peculiarly skilled, and he appears to have had a natural manipulative dexterity, which he assiduously cultivated. Like Sir Charles Bell and other eminent surgeons, he was a splendid fly-fisher; and his manipulation served him in good stead in acquiring skill on that most difficult of instruments, the violin. Carpentering and metal-working came easily to him, and gave him great readiness in improvising splints or other apparatus desirable for his patients’ special circumstances. Yet having such power and dexterity, he did not choose to display it on all possible occasions, but rather was conspicuous for his frequent abstinence from operative interference, counting it a greater glory to save a limb than to cut one off, and taking endless trouble to preserve a portion when amputation would have been much easier.

Although the rivalry between Fergusson and Syme frequently led to open dissensions, yet no man more freely, fully, and repeatedly acknowledged Syme’s great services than Fergusson. Thus he always ascribed the chief merit of the revival of the “conservative” operation of excision of the elbow-joint to Syme. Originally suggested by Park, and first performed by Moreau, it was not until the operation was taken up by Syme that it attracted serious attention. Fergusson followed in his wake, and extended the same principles till there was scarcely a part which could be conserved which he had not laid hands on with that object. To take an instance from parts of small size. A gentleman of active habits, in charge of a large establishment, to whom the use of a pen was of vast importance, had a bad whitlow at the end of his right thumb. An abscess was opened in due time, and the bone was found bare. Amputation was urged, but the patient objected, and on consulting Fergusson, he was advised to wait, and then a few weeks afterwards the portion of bone that died was removed through the original opening for the abscess. Before long, the thumb, apparently entire, was as useful as ever. “Opinions may differ,” says Fergusson, “but for my own part, I deem it a grand thing when by prescience even the tip of a thumb can be saved.”

To Liston’s boldness and rapidity Fergusson added greater caution and self-control. In lithotomy both were equally distinguished, and attained their end with the simplest instruments. An anecdote recorded in the Medical Times and Gazette (Feb. 17, 1877) illustrates this. Some practitioners were discussing the relative merits of some leading hospital surgeons, and introduced the subject of lithotomy. “I saw Mr. —— perform lithotomy to-day in half a minute.” “Oh,” replied B, “I saw —— once extract the stone in twenty seconds.” “Have you ever seen Fergusson perform lithotomy?” “No.” “Well then, go; and, look out sharp, for if you only even wink, you’ll miss the operation altogether.”

In 1845 Fergusson revived the plan of excising the head of the femur for incurable disease of the hip-joint, and it became established as a valuable operation, in spite of Syme’s violent opposition. In 1847 Mr. Fergusson excised the entire scapula, where the whole arm would otherwise have been sacrificed. In 1850 his attention became concentrated on diseases of the knee-joint, and before long he excised the joint for severe disease. Although the result was unfavourable, Fergusson, undismayed, repeated the operation successfully, and in spite of strong criticism and opposition, continued for at least fifteen years, it has become established. The strength of the feeling aroused on this subject was so great that once when Fergusson was about to excise a knee-joint at King’s College Hospital, a surgeon, once a colleague, publicly protested against the performance of the operation. Fergusson’s earlier cases were not always well selected for the operation, and he had many disheartening failures. But he persevered and improved in his selection of cases, and achieved what he regarded as the greatest triumph of conservative surgery.

Some of Fergusson’s greatest triumphs were in connection with hare-lip and cleft-palate. His first formal operation in surgery was for hare-lip in 1828. Up to 1864 he had operated on nearly four hundred cases with only three deaths. The adoption in 1850 of a spring or truss to push the sides of the lips forwards, invented by Jem Hainsby (the old dissecting-room attendant at Guy’s), and the father of a child-patient, was of great value in preserving the mobile parts of children from undesirable movements. In regard to cleft-palate Fergusson’s labours were of even greater value, for he discovered by careful dissection the reason why the edges of the wound were so often prevented from uniting, and by dividing the muscles concerned, in addition to other valuable improvements in practice, he enabled many patients to gain an excellent undivided palate. Up to 1864 he had operated on 134 cases, of which 129 were successful, and only two failed entirely. It is unnecessary to go through the long list of successes won by Fergusson; but it is well to mention that when he found the existing instruments unsuitable for his purpose, he never rested till he had invented better ones. The bull-dog forceps, the mouth-gag for operations on the palate, various bent knives, and many other instruments and apparatus bear the stamp of his inventive skill.

With all his operative brilliancy, that did not constitute Fergusson’s chief claim to admiration, nor was it the principal cause of his success. The perfect planning of the operation beforehand from beginning to end, down to the smallest detail, and being ready for every possible emergency with the precise method for meeting it, distinguished him most. Consequently he neither hurried, wearied, nor hesitated when he began. Things were so perfectly planned, his assistants so well drilled, that not a word needed to be spoken, and this produced a curious appearance at times, so that it was often remarked that he must be on bad terms with his assistants. He left no detail unsupervised, and completed the operation entirely himself, even applying bandages and plasters. His coolness under difficulty was probably connected with his forethought; he could often cover his own or others’ mistakes in the coolest manner, and this put him in the best position for remedying them. It was his pride never to be late. He hated unnecessary waste of time, and once when a friend intending to tie a large artery had laid it bare by a fine dissection, and was showing it with natural gratification, Fergusson called him to the point by remarking, “Jist put a thread round it.” So when a large artery had been wounded, and an assistant eagerly tried to stop the bleeding with his finger, Fergusson said: “Jist get your finger out of the way, mon, and let’s see what it is,” and satisfactorily tied the vessel.[4] He was remarkably neat too in his completion of an operation, and could not bear to leave any traces behind, either in hospital or private house.

In the subjects which he had thoroughly studied and on which he had practical experience Fergusson was a master. This is seen in his “Practical Surgery,” which reached a fifth edition in 1870, and in his lectures on the Progress of Anatomy and Surgery delivered at the College of Surgeons in 1864 and 1865. But as a systematic lecturer he did not achieve great success, nor was he conspicuous as a bedside teacher owing to his reticent manner. It was in operating that he shone most, and in his remarks on operations; to see him operate was for the student or practitioner already instructed what to observe a lesson full of practical value. On some important questions he was imperfectly informed, and this was proved when he opposed the movement for securing a pure water supply to large towns, and favoured the anti-vivisectionists in some remarks and evidence which showed considerable ignorance of physiological discovery and progress. Again, his attitude towards homœopathic practitioners largely compromised his influence at one time.

Fergusson’s social instincts as well as his personal sympathies won him favour from all classes, and his male as well as his female patients felt deeply his kindly attentions, while children simply worshipped him. His practice was always to treat a hospital patient with exactly the same consideration as one in private. Mr. Henry Smith records the profound impression made upon him as a young student by his remarkable kindness and gentleness towards a little lame boy. It is not to be wondered at that he inspired his patients with the utmost confidence, an art that many equally clever have lacked. A gentleman who came to London to have an enormous tumour of the lower jaw removed, saw several eminent surgeons, but chose Fergusson as the operator without hesitation. “Directly he put his hands upon me,” said this gentleman, “to examine my jaw, I felt that he was the man who should do the operation for me; the contrast between his examination and that of others was so great.” As Mr. Henry Smith says, “Fergusson not only shone pre-eminently as an operator, but he possessed a profound knowledge of his art, and wielded all its resources with consummate skill. His powers of observation were remarkable; his memory was most tenacious; his shrewdness, sound common-sense, tact and knowledge of men, and how to deal with them, were acknowledged by all; and conspicuous amongst them was that facility of resource in all trying emergencies, which, added to his extraordinary mechanical skill, made him what he was, and brought about a success which has seldom been vouchsafed to any surgeon.”

Fergusson became M.R.C.S., Eng., in 1840, and Fellow in 1844. He was appointed Surgeon to the Prince-Consort in 1849, and Surgeon-Extraordinary to the Queen in 1855, and Sergeant-Surgeon in 1867. In 1861 and again in 1868 he was elected to the Council of the College of Surgeons, notwithstanding the strong opposition of the existing council on the first occasion. In 1867 he became an examiner in surgery, and in 1870 President of the College. His lectures as Professor have already been mentioned. We may add that he was President of the Pathological Society in 1859 and ’60, and of the British Medical Association at its brilliant London meeting in 1873. His many other appointments and distinctions must be passed over, with the exception of the baronetcy, which he received in 1866.

Fergusson never tired of work. His fine energies kept him ever fresh. He could sing, or dance a Highland reel, with energy long after middle age, and when just returned from a prolonged and tiring journey. He was a munificent patron of literature and the drama; attended many an author without fee, and would not unfrequently pay for their lodging near him in cases where that was desirable. His spirit of hospitality was lavish, whether in London or at his seat at Spittlehaugh in Peeblesshire. He was ever ready to show kindly feeling towards even those who censured him most severely, and his forgiving nature was many times most conspicuously evident. Whenever he had any consciousness of having done or said anything calculated to wound another’s feelings, old or young, he never rested until he had made reparation in some way. He held a truly modest estimate of himself, was unspoiled by popularity, and never became at all overbearing. He was a staunch friend, to old pupils especially, and a liberal helper of members of the profession generally. Many a surgeon who has risen has owed to him essential help. Indeed, he displayed the best Christian characteristics, and was, in Mr. Henry Smith’s words, “the true type of a Christian gentleman.” He died in London, after an exhausting illness, of Bright’s disease, on February 10th, 1877, and was buried at West Linton, Peeblesshire, where his wife had already, in 1860, been buried. A portrait of him by Lehmann was presented by subscription to the London College of Surgeons in 1874, and a replica is in the Edinburgh College of Surgeons. His best monument is in the life and work of the multitude of his pupils, whom he influenced and stimulated as few have ever done.

FOOTNOTES:

[3] Surgery, Past, Present and Future, 1877.

[4] Henry Smith, Biographical Sketch of Sir W. Fergusson.

[CHAPTER XV.]
SIR JAMES SIMPSON AND ANÆSTHETICS.

Future ages will perceive in the history of medicine and surgery in the nineteenth century no more remarkable event than the discovery and the introduction of means for relieving and temporarily abolishing pain. And although the name of Simpson is by no means the only one honourably associated with this discovery, his achievement in the introduction of chloroform places him on an enviable pinnacle of greatness.

James Young Simpson, the seventh son and eighth child of a small baker, was born at Bathgate, Linlithgowshire, on the 7th of June 1811. His birth took place when his father’s circumstances were at the lowest ebb. Several of the family, including his mother, had but just recovered from fever. The mother had to rise from her maternal pain to take an active part in business, which she did most energetically and successfully. Her religious character and her thrifty habits deeply impressed the little boy, and he pleasingly recalled in after years her injunction, when she had just darned a big hole in his stocking, “My Jamie, when your mother’s away, you will mind that she was a grand darner.” She died when James was but nine years old, leaving him in the care of his only sister Mary, eleven years older, who proved a tender foster mother. Already as a child James Simpson became known as “the wise wean,” “the young philosopher,” and his voice was sweet and silvery. His industry and retentiveness of memory early gave promise of distinction, which all the family were persuaded would fall to his lot. And he would readily, book in hand, keep the shop for a time, or run with rolls to the laird’s house. “I remember,” says his brother Alexander,[5] “finding him sitting in the street on a very dusty day, sobbing bitterly, the tears running down his cheeks covered with dust. ‘What ails you, Jamie?’ I said, and he answered, sobbing as if his heart would break, ‘I’ve broken the pony’s knees.’” It turned out that Alexander himself had overridden the pony, so that it could not help stumbling.

The father of the family trusted his children in a peculiar way. All were regarded as equally concerned in the family prosperity, and the shop till was unfastened, and free to all; each habitually thought of the general good first. In this way the household prospered ever after James’s birth, and he personally received unremitting attention.

At the age of fourteen James Simpson entered Edinburgh University, “a very very young and very solitary, very poor and almost friendless student,” as he himself said forty years after. For two years he pursued classical and mathematical studies, gaining a small bursary before his second session. One of his earliest purchases was a little book on “The Economy of Human Life,” for which he gave ninepence. An extract from it which he wrote in his cash-book is significant of his temper of mind: “Let not thy recreations be expensive, lest the pain of purchasing them exceed the pleasure thou hast in their enjoyment.” Though an economical student, however, his literary tastes were wide, as he early bought Byron’s Giaour and Childe Harold, and Paley’s Natural Theology. He lodged with Dr. Macarthur, a former usher in the Bathgate School, together with John Reid, an old schoolfellow, afterwards Professor of Anatomy at St. Andrews, in the upper flat of a tall house in Adam Street. Reid’s enthusiasm for anatomy seem to have first inspired Simpson to choose medicine as a profession.

In the winter of 1827 James Simpson entered as a medical student in the University, and, attending Liston’s class on surgery, soon became conspicuous. He took full notes of lectures, and was freely critical of his teachers. He became a dresser under Liston, and received excellent testimonials from him. But he shrank from surgery, having an exquisite tenderness of heart which almost drove him from the profession. After witnessing on one occasion a poor woman’s agony under amputation of the breast, he started off directly to seek employment as a writer’s (or lawyer’s) clerk. He soon returned, however, deeply imbued with the desire to do something to render operations less painful. Simpson’s summer vacations were passed at Bathgate, natural history and antiquarian pursuits occupying his spare time. In January 1830, just before he was going up for his license to practise, his father died after some weeks’ illness, during which James constantly watched at his bedside. Such an interruption to study at a critical moment might have upset so sensitive a mind. But Simpson went in for his examination in April, and became a member of the Edinburgh College of Surgeons before he was nineteen years of age. His brother Alexander, who, with the rest of the family, furnished faithful and persevering help to the young brother of whom so much was expected, gave him a home while he looked out for some post to occupy him while waiting for his Edinburgh degree, which his youth prevented him from taking as yet. One of the situations which he sought was that of parish surgeon in a little village named Inverkip, on the Clyde. “When not selected,” he writes long after, “I felt perhaps a deeper amount of chagrin and disappointment than I have ever experienced since that date. If chosen, I would probably have been working there as a village doctor still.”

In 1831 Simpson returned to his university studies, his brother David having commenced business in Stockbridge, Edinburgh, and being able to accommodate the young doctor. He assisted in maintaining himself by becoming assistant to Dr. Gairdner. Thus he was enabled to complete his university course and take his M.D. degree in 1832, giving as his inaugural thesis an essay on “Death from Inflammation.” This attracted much attention, especially from Dr. John Thomson, Professor of Pathology, who at once requested him to act as his assistant with a salary of £50, which the young man made sufficient for all his necessities. In this capacity he prepared a catalogue of the museum of the pathological department. His first experience of obstetric study in attending Professor Hamilton’s lectures had not left his mind under a compulsion to pursue the subject deeply, but Dr. Thomson saw that his assistant, soft-mannered but full of decisive activity, was the very man to succeed in midwifery practice, and he therefore advised him to devote himself specially to it. Another great characteristic was his power of winning the confidence of others, and especially of getting his patients to tell him what it was most important that he should know. But he went immediately to work to become learned in his subject, and then to turn over in his mind everything that he had learnt, until it assumed a new aspect. He always sought new and better ways, and if any department of practice or theory appeared to him defective, he restlessly applied his mind to invent or imagine some improvement. And he had an absorbing desire to gratify his family by achieving success. When his sister Mary told him in 1834 he was injuring his health by overwork, he replied, seriously, “Well, I am sure it’s just to please you all.”

Simpson’s first important paper, on the Diseases of the Placenta, delivered before the Royal Medical Society in 1835, at once showed a master hand. It was translated into French, German, and Italian. He began by exhaustively studying the previous history of every subject he took up, and then tested others’ opinions and facts by his own observation. One of his earliest papers includes nearly one hundred references to previous literature, including many authorities, showing an unusual range of reading. If he could not read the language of an author he got some one who could to do so, and give him the material bearing on his point of inquiry. But while no man regarded more highly than he the patient achievements of the past, no man sat more loosely to tradition and convention.

In 1833 Simpson became a member of the Royal Medical and Physical Societies of Edinburgh. Of the former he was soon President. A writer in the Scotsman for May 10, 1870, thus described his appearance in that capacity. After speaking of his long tangled hair, and very large head, he says: “A poet has since described him as one of ‘leonine aspect.’ Not such do we remember him. A pale, large, rather flattish face, massive, brent brows, from under which shone eyes now piercing as it were to your inmost soul, now melting into almost feminine tenderness, and coarsish nose, with dilated nostrils, a finely-chiselled mouth, which seemed the most expressive feature of the face, and capable of being made at will the exponent of every passion and emotion. Who could describe that smile? When even the sun has tried it he has failed, and yet who can recall those features and not realise it as it played round the delicate lines of the upper lip, where firmness was strangely blended with other and apparently opposing qualities? Then his peculiar, rounded, soft body and limbs, as if he had retained the infantile form in adolescence, presented a tout ensemble which even had we never seen it again would have remained indelibly impressed on our memory.”

In 1832 Alexander and Mary Simpson both married. Alexander’s wife, however, became as attached as his sister to James, and there was no interruption to the family helpfulness. When cholera appeared in Bathgate, Alexander made a will securing a provision for James if he died. “I trust,” wrote this true brother, “every one of you will look to him. But I dare say every one of you has a pleasure in doing him good by stealth, as I have had myself.” The brothers Alexander and John enabled James to visit London and the Continent in 1835 to see a variety of practice; his travelling companion was Dr. Douglas Maclagan, afterwards Professor of Medical Jurisprudence at Edinburgh. On his return Simpson gained some practice, but chiefly among those who could pay him little or nothing. In May 1836 he obtained the situation of house-surgeon to the Lying-in Hospital, which he held for a year. This soon led to an increase of practice among better-paying patients. He now gave some courses of lectures on Midwifery in the Extra-Academical School, which were well received, besides being appointed interim lecturer on Pathology, when his friend Dr. Thomson had resigned. He gave great labour to the preparation of his lectures, besides continuing to publish original papers on Midwifery. At this time he rose repeatedly at three in the morning, when he did not sit up all night. But with all his work he found time for social enjoyment, for family interests, for messages to old schoolfellows in humble life.

Neither now nor at any time did Simpson lose his habit of plain speech. He did not always conciliate others by his outspoken expressions, and he did not care to wrap up unpleasant truths in honeyed words. In 1839 some hasty words which passed between Simpson and Dr. Lewins of Leith in reference to an anonymous letter written by the latter, nearly led to a duel; but, fortunately, friends were able to persuade them that both were to blame, and an amicable reconciliation was effected. In the same year, that in which also he had commenced housekeeping on his own account, Simpson became a candidate for the Chair of Midwifery, vacated by Dr. Hamilton’s resignation. The contest was a very severe one, Dr. Evory Kennedy of Dublin having strong claims. Simpson strained every nerve to secure testimonials and to influence electors, publishing an octavo volume of testimonials, extending to more than 200 pages. He was finally elected Professor on the 4th February 1840 by a majority of one vote only, at the age of twenty-eight, with no advantages of social position or long experience to back him. A few weeks previously (December 26, 1839) he had married his second cousin, Miss Jessie Grindlay, of Liverpool, to whom he had long been attached.

But difficulties were not over when the election had taken place. The pecuniary cost of the canvass was about £500, chiefly in printing and postage; and Simpson had less than no money; he was considerably in debt to his relatives. His new colleagues had to a large extent opposed him, preferring Dr. Kennedy; they continued to oppose him, not fancying their association with a small baker’s son. Practice began to flow in, but it necessitated taking a larger house, keeping a carriage, and much greater expenditure; and it was some time before the young couple could make both ends meet. Demands from old friends or from poor people for help, crowded on Simpson faster than fees; and his kindly heart did more for them than sober judgment would warrant. He frequently sat up all night writing for the press. He was beset remarkably early by philanthropic projectors, self-interested promoters, young aspirants to fame, and men anxious to bring forward a pill calculated to make people live to the age of Methusaleh, or desirous of the Doctor’s interest to get them permission to fish in one of his patients’ streams. Nervous headaches and acute pains began to cast their horrible shadows over his life; but work was scarcely ever remitted. His lectures were immediately a great success; he had the largest class in the University. Additional seats had to be supplied, and then there was not room for all to sit. His cares had meanwhile been increased by the birth of a daughter, a fortnight before the session began.

Simpson’s untiring activity could not content itself, however, with strictly professional subjects. Before the end of his first session of professional lectures, he began to work at a memoir which received the title of “Antiquarian Notices of Leprosy and Leper-Houses in Scotland and England.” In it he makes nearly five hundred references to out-of-the-way authorities, and in the appendix is a list and notices of one hundred and nineteen leper-houses which he had traced in Britain. The memoir is a mine of valuable antiquarian information.

By the end of 1842 his pecuniary position was assured beyond all doubt, although his benevolence would have made this difficult had not his skill become so famed. His success when little over thirty years of age was marvellous; the hotels were filled with his patients, and his practice was said to be worth many thousands of pounds a year to these establishments. His house had to be enlarged to receive some who insisted on remaining in the closest proximity to the great doctor. But in the whirl of practice one fault became prominent. Methodical and exhaustive in his literary researches, and possessed of a powerful memory, he could not be persuaded to make systematic notes of his appointments, and seemed to be incapable of so planning out his time as to spend it to the greatest advantage for his patients. He not unfrequently forgot a definite appointment, and was sometimes overpersuaded by pushing people or by professional friends to attend to cases out of their proper turn. That he ever consciously did any one an injustice either for pay or without it is quite untrue. But he was blamed as if he had. He was indeed only too careless about money, and frequently too regardless of his own interest to demand a proper fee. His receipts were stuffed at once into his pockets, which were emptied at night, he knowing nothing of their contents before. Sometimes a fee was received in a letter, and neither taken out nor acknowledged. Once he received £10 thus, when a much larger fee might have been expected, and several notes of expostulation followed on his neglect to acknowledge its receipt. One stormy night Simpson was much disturbed in sleep by the rattling of a window. He got up, felt in his pocket for a bit of paper, and lighted on the £10 note, which was devoted to the tightening of the window-frame. On Mrs. Simpson discovering the nature of the bit of paper in the morning, he merely replied, “Oh, it’s that £10.” A sample of ridiculous expostulations is the case where repeated letters asked Dr. Simpson’s opinion whether three leeches should not be applied to a hip-joint, instead of two, which the family medical man recommended.

In the midst of practice and lectures, he found time to write or dictate many a brief or lengthy article on obstetric practice or diseases of women, always practical, always exhausting previous authorities. It was in this direction especially that his mind was ever at work. Then when he had come to a conclusion, he withheld no item of it. “Keen to perceive the truth,” says the Scotsman,[6] he was equally vigorous in his announcement of it, and cared little to what cherished opinion his statements might run counter. Hence came contests where little quarter was given or received. He was a dangerous antagonist to meet at a joust, and though he could use the keen edge of steel, he oftener despatched his antagonist with a heavy mace of facts or figures, which those who had neither his industry nor his powers of memory could neither refute nor set aside. Hence he made many enemies, for he had run counter to many prejudices, and the old spirit which had opposed his election to the professorial chair cropped out ever and anon, showing that it was smothered, not extinguished.

It should ever be remembered that Simpson’s greatness was established before he had introduced chloroform, and depended on his unsurpassed skill in obstetrics and diseases of women, while yet he was a most accomplished general physician. Already, in January 1847, when he was only just beginning to study anæsthetics, he was made one of the Queen’s Physicians for Scotland. We cannot here attempt a history of previous efforts to secure immunity or relief from pain, but it is evident Simpson was in this respect not a man marvellously in advance of his age; the subject was in the air; unceasing efforts at improvement were being made. Before the end of the last century the brilliant chemical discoveries of Priestley had led to his suggestion that drugs might be administered in definite quantities by inhalation through the lungs. Oxygen was the first gas inhaled for medicinal purposes; and in 1795 Dr. Pearson of Birmingham prescribed the inhalation of ether in cases of consumption, being followed ten years later by Dr. Warren of Boston, U.S.A. In 1800 Sir Humphry Davy, when superintending Beddoes’ Pneumatic Institution at Bristol, founded principally for the medicinal inhalation of oxygen, began to study the effects of nitrous oxide, which he employed, after he had become familiar with its intoxicating effects, to relieve the pain of a severe inflammation of his own gums. In publishing his account of its successful inhalation he said, “As nitrous oxide in its extensive operation seems capable of destroying physical pain, it may probably be used with advantage during surgical operations in which no great effusion of blood takes place.”[7] Thus we must credit Sir Humphry Davy with the most original observation and experiment on the subject of anæsthetics: another instance in which the investigator seeking to advance science has made an observation and suggestion bearing on the welfare of the whole of mankind. His pupil and successor, Faraday, in 1818 announced that sulphuric ether vapour, when inhaled, produced similar effects to nitrous oxide. Here closes the record of anæsthetics for many years, practically we believe because medicine and surgery had not yet become sufficiently scientific to discern their value.

In 1835 Robert Collyer, an American medical student, inhaled ether at a chemical lecture by Professor Turner at University College, London, being himself made insensible, in company with other students; he noted that his fellow-students under its influence became insensible to pain. In December 1839, Collyer, near New Orleans, reduced a dislocation of the hip for one of his father’s negroes who had fallen down in insensibility on inhaling the fumes of rum. The negro showed no sign of pain. Collyer soon after identified this narcotic state with that produced by mesmerism, under which also some operations were painlessly performed. Collyer lectured on these subjects in 1840 and subsequent years in Philadelphia, Boston, Liverpool, and other places. He made mesmeric and narcotising experiments, the latter with a mixture in which the vapour of alcohol with poppy seeds and coriander steeped in it was inhaled, and in 1842 he states that he administered his alcoholic mixture to a patient in Philadelphia, during tooth-drawing, with a painless result. In 1844 an American chemical lecturer named Coulton exhibited the properties of nitrous oxide at a lecture given at Hartford, Connecticut, at which Horace Wells, a dentist practising there, was present. Having a tooth which he himself wished to get extracted, Wells invited Coulton to administer nitrous oxide to him. This was successfully done, and during Wells’ insensibility his tooth was removed by a friend, Dr. Riggs. Wells on recovering consciousness exclaimed, “A new era in tooth-pulling!” and at once attempted to introduce the practice at Hartford and at Boston; but not using the gas in purity, and not being sufficiently skilful in its administration, his attempts often failed, and at Boston he was hissed, and gave up his efforts in despair. Later, when anæsthetics had become firmly established, he again sought unsuccessfully to introduce nitrous oxide, and at last put an end to his life. It is sad to think of this fate for a man who, with a little more education and a little more perseverance, might have reaped a great harvest of fame.[8]

We cannot go into the controversy as to which American has the greatest merit in the introduction of sulphuric ether as an anæsthetic. Suffice it to mention that Charles Jackson, a chemist of Boston, who had been present at Wells’ demonstration in 1840, first experimented on himself by inhaling pure sulphuric ether, and having produced insensibility, communicated his discovery to W. T. G. Morton, a dentist who had been present at Wells’ demonstration, and prevailed on him to employ it. Morton afterwards alleged that this step was taken independently on his part.

On September 30, 1846, Morton administered ether to Eben Frost for tooth-drawing with complete success, and in October following it was used in an important operation by Dr. J. C. Warren at the Massachusetts General Hospital. The news arrived in England before the end of 1846, and on December 19th, James Robinson, a dentist of Gower Street, London, was the first to operate under ether in this country for the removal of a tooth. On December 21 Robert Liston employed it most successfully at University College Hospital in an amputation of the thigh and in the removal of a great toe-nail, one of the most exquisitely painful operations. Its general adoption followed in the first few months of 1847. Dr. Simpson, as early as January 9, 1847, after previously inhaling it himself, used it in order to relieve pain in childbirth, and found that its anæsthetic effects produced no stoppage or perceptible alteration in the muscular contractions of the womb. This and other cases of his were quickly published, and justify his claim to having introduced ether in its application to midwifery practice.

The inconveniences occasioned by the smell of sulphuric ether, the considerable doses required to be given, and its tendency to irritate the bronchial tubes, led Simpson to inquire for and to try other analogous liquids. He was recommended, among others by Dr. Gregory, to try chloroform, discovered by Soubeiran in 1831 and Liebig in 1832, and accurately investigated by Dumas in 1835. He concluded after much labour, and the expenditure of some hundreds of pounds, that chloroform, without the unpleasant smell of ether, produced more rapid effects with a smaller dose, and he very soon began to use it in midwifery and to introduce it to his surgical friends for operations. It was brought before the Edinburgh Medico-Chirurgical Society on the 10th November 1847; and so well-known and favoured did it become that in a very short time Simpson’s Edinburgh chemists were manufacturing 7000 doses a day. Here we might almost stop in this record, but for two things, one the controversies Simpson had as to the impropriety and irreligiousness of removing pain, supposed to be one of the Creator’s ordinances which ought not to be mitigated; and the other, the deaths that began to occur under the administration of chloroform. As to the first, a specimen of the objectors is furnished by a clergyman, who wrote “that chloroform was a decoy of Satan, apparently offering itself to bless woman; but in the end it will harden society, and rob God of the deep earnest cries which arise in time of trouble for help.” Even the relief of pain in surgical operations was held by many to be unwarrantable. But a powerful counter-argument was found, in the much greater ease and certainty of success with which surgeons could now perform their operations when the cries and writhings of the patient were removed. The controversy that ensued, however, would fill a volume, and Simpson in it proved himself, as ever, a hard hitter.

For many years scarcely anything but chloroform was used for producing anæsthesia; but gradually numerous unexpected deaths under its administration led many to think that it had too depressing an effect on the action of the heart, in some cases at least, and led to the trial of other agents, including bichloride of methylene, the reintroduction of ether, and nitrous oxide. The two latter are very largely used at present, and so also is a mixture composed of one part by measure of alcohol to two of chloroform and three of ether, also known as the A.C.E. mixture, from the first letters of the three constituents. This is now considered by many to be safer than chloroform. What will be the judgment of future experience we can have no pretensions to decide.

We cannot give in detail the subsequent events of Dr. Simpson’s life. It became more busy and active, more benevolent, and more distinctly religious as years went on. He refused advantageous offers to settle in London, and instead patients came from all parts of the world to consult him in Edinburgh. His hospitality was unbounded. His daily breakfasts and luncheons have been graphically described by a well-known poet. “Assembled unceremoniously in a moderate-sized room, with little in common save the wish to meet their host, you found a company drawn together from every latitude and longitude, social and geographical. Of all this motley party there is probably hardly one who is not notable, and the grades and classes of eminence run through the whole gamut of social distinction from duchesses, poets, and earls, down to the author of the last successful book on cookery, the inventor of the oddest new patent, a Greek courtier, a Russian gentleman, or a German count. At your elbow the last survivor of some terrible shipwreck is telling his story to the wife of that northern ambassador, who is meeting, with the softest Scandinavian dialect, the strong maritime Danish of the clever State secretary opposite. Behind you a knot of American physicians, just arrived, are discussing in a loud voice, a speech in Congress, or agreeing, sotto voce , on the particular professional topic upon which they have come to consult the great authority. Turn for a moment from this sculptor, who is waiting to ask the opinion of the many-sided professor on the sketches which he is now showing to that portrait-painter, and to learn which of them shall be done in marble for the nobleman whose attention the doctor has found time to direct to the rising young artist, and you may catch something of yonder violent discussion between those arrivals from Australia, who have come from the land of gold in search of what gold cannot buy.”

But it is by no means only in connection with ether and chloroform that Simpson introduced a new practice. Besides numberless suggestions and novel ideas in midwifery, he brought forward (in 1859, after some years of study) a totally new method of closing arteries after operations and in substitution for ligatures, so often the cause of inflammation. Long before John Hunter had pointed out that needles and pins when passed into and embedded in the living body seldom or never produced any inflammatory action. Simpson was struck with the idea that slender sharp-pointed needles or pins of non-oxidisable iron, somewhat like hare-lip needles, might be used to close together the walls or flaps of wounds, at the same time keeping the blood-vessels closed. These pins could be withdrawn very early, and would greatly favour healing at the earliest possible moment. The new method, called acupressure, of course met with much opposition, and Simpson was severely censured for meddling in a preserve strictly limited to the surgeon. But the help of the Aberdeen surgeons, Keith and Pirrie, was of great service in promoting the fair trial of the practice. His attack on the prevailing hospital system in 1869 was one of his later crusades, and he certainly accumulated a great store of facts showing the unhealthiness of the existing conditions of aggregation in crowded hospitals. His advocacy of a separate system in hospital construction, and of limiting the number of patients close together, of course drew on him further fierce opposition. We cannot here refer to his strong exposure of the fallacies of homœopathy, his vigorous actions in connection with the University of Edinburgh, or the numerous antiquarian papers which his prolific pen gave forth. Every year had crowded into it three times as much research as a very industrious man could manage, ten times as much controversy, and twice as much practice. Honours came thick upon him. In 1856 he was greatly gratified by the French Academy’s award of the Monthyon Prize of 2000 francs for “most important benefits done to humanity.” At the beginning of 1866 he was created a baronet. In 1869 the freedom of Edinburgh was presented to him.

Heavy affliction came now and again to embitter his life. Several children were taken from him in the prime of their life, including his eldest son, who showed great promise of a brilliant medical future, but was cut off within a fortnight after his father was made a baronet. In later life he became an ardent church worker, having joined the Free Church of Scotland when the Disruption took place. 1870 found the vital machine much out of order. Heart pain—angina pectoris —so often the scourge of medical men, came more frequently with its terrible strain. But he never relaxed his work in the intervals, until absolutely compelled. In one of his later conversations he said, “How old am I? Fifty-nine. Well, I have done some work. I wish I had been busier.” One of his expressions showed his distaste for theology. “I like the plain simple Gospel truth, and don’t care to go into questions beyond that.” During almost his last night he was inexpressibly comforted by having with him his brother Alexander, who had watched over him with such tenderness from childhood. He sat on the pillow with Sir James’s head on his knee, and the sufferer again and again slowly uttered the words, “Oh, Sandy, Sandy!” He died on May 6, 1870. He would have been buried in Westminster Abbey but for his own express wish to be buried in Warriston Cemetery, Edinburgh. His funeral was such as Edinburgh had, it is said, never witnessed before, business being generally suspended. His widow survived him but a few weeks, dying on the 17th June following. His eldest surviving son, Walter Grindlay, succeeded him in the baronetcy.

FOOTNOTES:

[5] Memoir of Sir James Y. Simpson, by J. Duns. Edinburgh, 1873.

[6] Scotsman, May 9, 1870.

[7] Researches, Chemical and Philosophical, chiefly concerning Nitrous Oxide and its Respiration. By Humphry Davy. London, 1800.

[8] Lancet, 1870, History of Anæsthetic Discovery.

[CHAPTER XVI.]
SIR SPENCER WELLS AND OVARIOTOMY.

Thomas Spencer Wells, whose career in the revival of the operation of ovariotomy has attracted very widespread attention and interest, was born in 1818, being the eldest son of Mr. William Wells of St. Alban’s, Herts.

Without being formally apprenticed, he enjoyed many of the advantages of the old apprenticeship system, under an able country practitioner, Michael Thomas Sadler, of Barnsley, Yorkshire. Subsequently he spent a year with a parish doctor in Leeds, attending the Leeds Infirmary, and Hey’s and Teale’s lectures. The session 1837-8 was passed in Dublin, and there Graves and Stokes largely influenced the young surgeon. Continuing his course of culture in varied fields, he went to St. Thomas’s, London, and was a zealous pupil of J. H. Green, Travers, and Tyrrell. Here he obtained a prize for the best reports of post mortem examinations. Becoming a member of the College of Surgeons in 1841, he entered the navy as assistant-surgeon, and spent six years in the Naval Hospital at Malta.

In 1853 Sir Spencer Wells settled in practice in London, and in 1854 became attached to the Samaritan Hospital, then a dispensary for the diseases of women. At this time Sir Spencer states he knew less of this branch of the profession than of any other. In his younger days he had attended an unusual number of midwifery cases, but latterly his practice had been almost exclusively surgical, with a strong tendency towards ophthalmic surgery. It was at this time that he first became interested in the subject that has made his name so widely known.

From time immemorial the ovaries of women have been subject to diseased growths and fluid accumulations, for which there was scarcely a remedy, except when fluid could be drawn off through one or more punctures, and fatal results were the almost inevitable sequel of these diseases. Towards the end of the seventeenth and beginning of the eighteenth centuries, several medical men proposed to remove the diseased organ by an incision in the front wall of the abdomen. William Hunter in 1762 put forward a method by which this operation, otherwise full of danger, might be rendered feasible; and John Hunter, lecturing in 1785, favoured the idea of removal, considering that the opening would not necessarily constitute a highly dangerous wound. In 1798 Chambon, in a book on diseases of women, published at Paris, strongly argued in favour of the operation. Although it does not appear that he ever himself performed it, he says, “I am convinced that a time will come when this operation will be considered practicable in more cases than I have enumerated, and that the objections against its performance will cease.” John Bell also has a share of credit in this matter, for in his lectures on surgery at Edinburgh in 1794 he dwelt with much force on the practicability of removing ovarian tumours by operation. It was reserved, however, for a pupil of his, Ephraim M’Dowell, from Virginia, to perform the first modern operation of ovariotomy for disease. He settled in practice in Kentucky in 1795, and in 1809 carried into effect this novel operation upon a middle-aged woman, who survived to complete her seventy-eighth year in 1841. Thus an American had the glory of first boldly starting in the new path.

It was difficult to give the new operation a start in England. “It must be remembered,” says Sir Spencer Wells, “that, at that time of day, the mortality from all operations was much greater than it is now; that the sick and diseased were more passively quiescent under their maladies and less tolerant of any surgical suggestions, just as we ourselves find to be the case among the unroused population of an outlying agricultural district; that they were not buoyed up, as modern women are, by the histories and promises of painless extirpations under chloroform or methylene; and that, without any mawkish sentimentalism, surgeons themselves had to encounter the peine forte et dure of their suppressed sympathy, and nerve themselves up to the infliction of the most deliberate and tedious eviscerative vivisection. The disease was looked upon as a mystery, and its ending in death as a matter of course; and, instead of being accompanied, as we now see it, by fretful resistance and chafings to escape, it only led to stolid endurance or religious submission; and on the part of the profession, to pity and endeavours to alleviate the inevitable misery. But M’Dowell was a free man, in a new country, clear from the conventional trammels of old-world practice, found his patients in the most favourable conditions of animal life, seems to have had one of those incomprehensible runs of luck upon which a man’s fate and reputation so often turn if he has the sagacity and energy to put such fortunate accidents to good account, and was happy, as those usually are who can afford or constrain themselves to wait, in finding suitable time, place, persons, and opportunity for working into fact the notions of his tutor, Bell. He lost only the last of his first five cases of ovariotomy, and thus, as it were, established at the outset what until recently was complacently regarded as a satisfactory standard of mortality for so serious an operation.”[9]

As a surgeon M’Dowell was “cautious, calm, and firm, paying great attention to the details of his operations and treatment, and selecting and drilling his assistants with great care.” In 1879 a granite obelisk was raised to his memory in the cemetery where he was buried, near his home, in commemoration of his courageous and important work.

Long after M’Dowell’s operations became known, a case was discovered as far back as August 1701, in which Robert Houstoun, a Glasgow surgeon, operated on a woman for a large tumour in a fashion somewhat anticipatory of modern ovariotomy. She recovered, and lived sixteen years afterwards. So often are anticipations of great improvements to be found, that it appears that the merit, like the difficulty of actually making a thing practicable and practised, is as great as, or greater than, that of discovery.

Several American surgeons followed M’Dowell, but the operation did not come rapidly into vogue, partly because anæsthetics had not yet been introduced. Lizars of Edinburgh had one successful and one unsuccessful case in 1825. Dr. Granville attempted it in London in 1827, but the operation was abandoned on account of the difficulties met with: fortunately the patient recovered. In 1836 Dr. Jeaffreson of Framlingham first operated successfully by means of the short incision recommended by William Hunter; the patient recovered and bore a family afterwards. In the same year several other provincial surgeons were equally successful. In 1840 Mr. Benjamin Phillips operated unsuccessfully at the Marylebone Infirmary. In 1842 Dr. Charles Clay of Manchester commenced a long series of operations, operating four times in the year, three times successfully. The first successful case in London was by Mr. Walne in November 1842. From this time operations were not infrequent. In September 1846 Mr. Cæsar Hawkins proved for the first time that success was possible in a London hospital; his precautions and his directions were most excellent. In June 1848 Dr. Charles Clay published a series of 32 cases with only 10 deaths, and he continued to operate for many years until he had performed 395 operations with only 101 deaths, slightly above 25 per cent. He used long ligatures. In 1850 Mr. Duffin, in London, employed an important improvement in procedure.

Sir Spencer Wells’s medical education and study in all these years had not led to his paying any attention to the subject. It was evidently outside the prevailing ideas of most of the medical schools. His opinion in 1848 was certainly against the justifiability of the operation. In 1853 or 1854 he became acquainted with Mr. Baker Brown, and in the latter year assisted him at the Middlesex Hospital in his eighth case of ovariotomy. This was the first time he had seen the operation attempted, but the patient died. Several unsuccessful cases led Brown to give up his attempts entirely from March 1856 to October 1858.

When the Crimean War broke out, Sir Spencer Wells betook himself to the army in the East. There he learnt much of the freedom with which the abdomen might be injured and yet recovery take place if the constitution was good and other things were favourable. He saw frightful cases of laceration by fragments of shell recover after careful cleansing and accurate closure of the wounds. He returned to London much less afraid than before of abdominal wounds. Renewing his work at the Samaritan Hospital, he at first saw very little of ovarian disease, and it was not till December 1857 that he made his first attempt to perform ovariotomy, which, however, on Baker Brown’s advice, he did not carry to completion. His second attempt was completed, with Brown’s assistance; but the latter did not recommence to operate himself until after an interval of more than two years and a half.

Sir Spencer Wells has given a graphic account of his early experiences.[10] “It would be difficult to imagine,” he says, “a position more disheartening than that in which I was placed when making my first trials of ovariotomy. The first attempt, as I have said, was a complete failure, and strengthened not only in the minds of others, but in my own mind, the fear that I might be entering upon a path which would lead rather to an unenviable notoriety than to a sound professional reputation. And if I had not seen increasing numbers of poor women hopelessly suffering, almost longing for death, anxious for relief at any risk, I should probably have acquiesced in the general conviction—have been content with palliative tapping, or making some further trials of incision and drainage, or of iodine-injection, or of pressure, rather than have hazarded anything more in the way of ovariotomy. It may be forgotten now, but it is true, that at that time everything was against the venture. The medical press had denounced the operation, both in principle and practice, in the strongest terms. At the medical societies the speakers of the highest authority had condemned it most emphatically. The example of the men who had practised it was not followed; some of them had given it up. Only once had a successful result been obtained in any of our large metropolitan hospitals, that by Cæsar Hawkins, at St. George’s Hospital, in 1846, and he never undertook it a second time. Every other attempt—at Guy’s Hospital by Morgan, Key, and Bransby Cooper, at St. Thomas’s by Solly—had ended in death.” In 1858 three cases were undertaken, and all with success, which did much to confirm Mr. Wells in his new practice. The fourth he lost, and to explain the cause he made some experiments upon animals, which led to important improvements in methods, yet during 1859 five out of eleven operations had fatal results.

The translation in 1860, by Mr. John Clay of Birmingham, of Kiwisch’s “Diseases of the Ovaries,” with its valuable tables showing the results of all recorded cases, was of great importance to the progress of ovariotomy. Since then vast improvements have been introduced, the mistakes of earlier operators corrected, bichloride of methylene has been used with gratifying results instead of chloroform, precautions have been taken to prevent the access of any taint of infectious disease, every medical man present at the operation has been put under strict inquiry as to his not having recently been in a dissecting or post mortem room, and the utmost possible purification of house, room, bedding, clothing, and instruments has been practised. Indeed some precautions have been so stringently insisted on as to give considerable offence at times. The old vegetable material for ligatures and sutures, coarse whipcord or twine, has been given up, and after many trials of metallic wires pure silk has been settled upon as the most trustworthy. In fact it is entirely absorbed without needing to be pulled out again. The multitude of intricate details involved precludes our giving an account of the stages by which the present perfection has been reached. In 1864 Mr. Wells, in pursuance of a pledge he had given to record and publish his entire experience, favourable and unfavourable, published a full account of his first 114 cases. Since then two extended records, one in 1872 giving an account of 500 cases, and a second in 1882 with 1071 cases, have been published. The most remarkable thing in the history is the gradual diminution in mortality. In the first hundred cases the deaths were thirty-four; in the last they diminished to eleven; in the seventy-one cases following the first thousand only four died, while sixty-seven recovered. This is notwithstanding the fact that Sir Spencer Wells is often called upon to treat patients rejected by other surgeons as unfavourable cases. A recent record by Thomas Keith, an Aberdeen surgeon, in which a mortality of only three and a half per cent. has occurred, even outdoes this astonishing result. It is needless to relate how the operation has been adopted by most Continental surgeons of mark, and with excellent results.

We may note that already in 1864 Mr. Wells had treated of hospital atmosphere, organic germs as causes of excessive mortality, and commented on the researches of Polli with sulphur and the sulphites, before as yet the antiseptic treatment had come prominently forward. When Mr. Lister’s system became established, Mr. Wells gladly adopted all its essentials in his operations—the spray, carbolised sponges, instruments, &c. He is convinced that by these precautions those patients who have recovered have suffered much less from fever, while convalescence has been more rapid than it used to be. In fact, the general result of the ovariotomy of the past twenty-five years is “thousands of perishing women have been rescued from death; many more thousands of years of human life, health, enjoyment, and usefulness have been given to the race, and to all future victims of a malady before inevitable in its fatality, consolation, hope, and almost certainty of cure.”

The good influence of this success has, Sir James Paget says, extended to every department of operative surgery, and will always continue to be felt. It has led to an extension of the whole domain of peritoneal surgery, leading surgeons to attempt and persevere until successful in many operations formerly considered quite out of reach.

Sir Spencer Wells is by no means content with promoting the progress of operative surgery; he looks forward to prevention with the greatest hope, and advocates measures calculated to promote accurate research in pathology. He is a strong supporter of any possible action by the College of Surgeons in this direction. He says: “While we modern surgeons congratulate our science on its liberation from the trammels of tradition; upon its working in an atmosphere cleared of the mist of superstition; upon the changing of its mode of action from a blind grappling with the phantom entities of a disease to a study and manipulation of overnourished or degenerating tissues; upon its having laws which can be understood and rules of practice which can be followed, we ought not to overlook one fact, which perhaps is more evident to outsiders than to ourselves, standing as we do in the dust and turmoil of the arena of our work. I mean that that work, good and useful as it is, has too much the character of what is technically called ‘salvaging’—is too much in correlation with what is done by the lifeboat service.”

Mr. Wells had long been a member of the Council of the College of Surgeons when in 1882-3 he became its President. In 1882 he was created a baronet. He has by no means limited himself to questions of operative surgery. His public efforts have been frequently directed towards important subjects of state and municipal polity, sanitary matters, the abatement of the smoke nuisance, the securing of the health of passengers on board ship, the hygienic condition of hospitals, and perhaps most important of all, the mode of disposal of the dead. His views on the evils of the present system are well set forth in a letter he addressed to the Times on March 3, 1885, from which we make the following extract:—

“In this metropolitan district in the twenty-five years 1859-1883, the deaths registered number 1,896,314. Of course, the dead have been buried, and with scarcely an exception, in and around London. Grant that in ten years a body may become harmless—although I do not at all believe that it does so within twenty years in our soil and climate—can any imagination conceive the enormous mass of decaying animal matter by which we are surrounded? Could any one be surprised at the outbreak of some devastating pestilence a hundredfold more destructive than the plague or black death of the Middle Ages? And ought not every sanitary reformer to aid the revival of the ancient practice which would convert the existing cemeteries, so rapidly becoming sources of danger to the public health, into permanently beautiful gardens, receptacles for vases and cinerary urns, which would encourage sculpture, mural decoration, and coloured glass-work; while in our country churches the ashes of the people might again repose in death near the scene of their work in life perfectly harmless, instead of polluting the earth of the church-yard and the water drunk by the surviving people, or being carried far from their homes and places of worship to some distant cemetery, which before long must become overcrowded and pestilential. Public sentiment may for a time revolt at an innovation, but a very little reflection will bring most people to agree with part of the Bishop of Manchester’s address on consecrating a new cemetery. He said:—

“‘Here is another hundred acres of land withdrawn from the food-producing area of the country for ever.... In the same sense in which the “Sabbath was made for man, and not man for the Sabbath,” I hold that the earth was made, not for the dead, but for the living. No intelligent faith can suppose that any Christian doctrine is affected by the manner in which, or the time in which, this mortal body of ours crumbles into dust.’”

Sir Spencer Wells in his frequent communications on the subject lays much stress on the fact that such undoubted proofs of natural death are required by the Cremation Society before cremating a body that no murderer or poisoner would think of getting the forms filled up. At the Milan Crematorium a death from poison was actually discovered in this way, when natural death only was believed to have taken place.

FOOTNOTES:

[9] Ovarian and Uterine Tumours: 1882.

[10] Address to Midland Medical Society, Birmingham, November 5, 1884.

[CHAPTER XVII.]
SIR WILLIAM JENNER, BUDD, MURCHISON, AND TYPHOID FEVER.

In no department of medical knowledge has recent progress been more marked than in the discrimination and the tracing of the natural history of the diseases known as zymotic: and no man takes higher rank in this department of investigation than Sir William Jenner. He was born at Chatham, January 30, 1815, being the son of Mr. John Jenner, and educated at University College, London. After qualifying as a general practitioner, he commenced practice and obtained the appointment of Surgeon-Accoucheur to the Royal Maternity Charity. Before long he graduated M.D. at London University (1844), and retired from general practice. His studies in pathology became more and more extensive, and his merits were so far recognised that in 1849 he was elected Professor of Pathological Anatomy to University College, and Assistant-Physician to University College Hospital.

For some years Dr. Jenner had been assiduously studying in the London Fever Hospital, seeking to make a straight path through the many knotty questions then, in debate. In April 1849 he commenced the publication, in the Monthly Journal of Medical Science, of his classic paper on “Typhoid and Typhus Fevers, an attempt to determine the question of their identity or non-identity, by an analysis of the symptoms, and of the appearances found after death in sixty-six fatal cases of continued fever, observed at the London Fever Hospital from January 1847 to February 1849.” In this he states that “with few exceptions, British physicians have laboured to prove that typhoid and typhus fevers are identical. The results obtained by this analysis justify the assertion that they are essentially distinct diseases.... For two years, in distinguishing the two diseases by the eruption alone not a single error has been made, so far as could be proved by examination after death of the fatal cases, or by the progress of the non-fatal cases after their diagnosis was recorded.”

The history of previous investigations and the fluctuations of opinion are excellently given by Dr. Murchison in his great work on the “Continued Fevers of Great Britain,” 1862, 2d ed. 1873. Dr. H. C. Lombard of Geneva appears to have been the first to state positively (in 1836) that “there were two distinct and separate fevers in Great Britain; one of them identical with the contagious typhus, the other a sporadic disease, identical with the typhoid fever of the French.” He failed, however, to point out the distinctive eruptions and other characteristics of the two fevers. At the same period Drs. Gerhard and Pennock in Philadelphia arrived at more definite conclusions, and distinguished the typhus of Philadelphia as being the same as British typhus, the old gaol, camp, and ship fever, so direfully contagious and fatal; while certain intestinal phenomena were invariably found in the other or typhoid fever, which was rarely contagious. The characteristic eruptions and many of the symptoms were also accurately discriminated. These observers were followed by others who with more or less success and emphasis insisted on the same views. Among these were Drs. H. C. Barlow and A. P. Stewart, both of whom read important papers on the subject before the Parisian Medical Society in 1840. In 1841 the celebrated Louis in the second edition of his great work on typhoid fever accepted the view that the English typhus was very distinct from the fever which he had so largely elucidated. Nevertheless many physicians of authority strongly maintained their identity, and the majority of the medical schools taught this doctrine, which could not fail to retard progress. It is obvious how much uncertain and injurious treatment must have existed for a long period owing to the confusion of these two diseases.

In his series of papers published in 1849 and 1850 Dr. Jenner confirmed and extended the distinctions between the symptoms of the two fevers, comparing the selected cases most minutely as regarded previous health, complexion, sex, age, mode of attack, duration, eruption, expression during disease, manner, hue of face, presence of headache, delirium, loss of muscular power, sensation, appearance of the tongue, suffering of pain, appetite, thirst, pulse, cough, and lung symptoms, and many other particulars, and detailed most carefully the post mortem appearances of the diseased action in every organ.

As regards the age of patients, he showed by calculation that typhoid usually attacked much younger patients than typhus, the average age of his cases of the one being 22 years, of the other 42 years. In typhus, death took place on the average on the fourteenth day, while in typhoid the average was the thirty-second day of residence in the hospital. The rose rash of typhoid, disappearing completely on pressure, resuming the original appearance on the withdrawal of pressure, was clearly discriminated from the mulberry rash of typhus. His post mortem observations may be considered to have given the death-blow to the idea that typhoid was merely typhus fever with abdominal complications. In closing the series of papers (April 1850) Dr. Jenner remarked, as to the suggestion that he had drawn general conclusions from a too limited number of facts, “A few facts, impartially observed, minutely recorded, and carefully analysed, are, I believe, more likely to give correct results than a multitude of general observations; and moreover, I believe most men would be astonished if they had in numbers all the cases of any given disease they had ever seen, yet concerning which they have generalised. The method I have adopted—however prolix it may be, however difficult to conform to, however tedious the details into which it leads—has this advantage, that if the observer be honest, and capable of noting what is before him, thinking men may judge of the value of his facts, the force of his reasoning, and the correctness of his conclusion; whereas general observations, while they are totally incapable of proving anything, are exposed to all the fallacies of definite statements, because the one, like the other, rests ultimately on the accuracy of the facts observed. If the observations on which any reasoning is founded be erroneous, no cloaking of those observations in general terms can render the conclusions correct. It has been objected to definite numerical statements that they mislead the reader by an appearance of accuracy in cases where there has been great inaccuracy in observation. This objection appears to me to lie against the condition of the reader’s mind, and not against the method.... The more complicated the problem to be solved, the more careful ought we to be that every step in its solution is made correctly. How complex questions, such as arise in medicine, are to be determined mentally—i.e., without the aid of figures—by ordinary men, I am at a loss to conceive. Yet physicians think to solve, by mental reveries, problems in comparison with which the most difficult that the most renowned calculators ever answered were child’s play; and not only do they think to solve these problems, but to carry in their minds for years the complicated materials by which they are to be solved.”

Another important branch of Dr. Jenner’s inquiry dealt with the question as to whether the specific cause of these diseases is distinct or the same, the latter being then the preponderant opinion. In a paper on this subject communicated to the Royal Medical and Chirurgical Society, on December 11, 1849, he showed that in 1847-8-9, on analysing all the cases in which two or more fever patients came from the same house, scarcely a single instance occurred where typhus and typhoid came at the same period from the same house. In nearly all cases the two diseases came from quite distinct localities. No transitional cases occurred between the two; the rash of typhoid did not graduate into that of typhus. It was several times observed that when a succession of cases came from the same locality, or arose apparently from the same cause, they agreed remarkably in symptoms or other features. Thus Dr. Jenner considered he had definitely proved that typhus and typhoid proceeded from perfectly distinct causes, a result which recent medical science accepts without reserve.

Although the contributions of this distinguished physician have been of such high worth, and his subsequent success so great in practice, he is far from being wedded to the view that any great step forward in medicine has been the direct result of the labours of a single man. Long after his early papers, in addressing the British Medical Association in 1869, Sir William Jenner said: “The silent workers render most efficient aid, the results of their unspoken experience confirming or refuting the published assertions of the few.” He believes that no science has advanced more during the present epoch than medicine, and that it has progressed equally as a practical art.

Dr. Jenner’s appointments include, among a crowd of others, those of Physician to University College Hospital (1854), Professor of Clinical Medicine (1857) and of the Principles and Practice of Medicine (1862), Physician to the Hospital for Sick Children (1852), Assistant-Physician to the Fever Hospital (1853). In 1864 he was elected Fellow of the Royal Society, and became President of the College of Physicians in 1881. In 1861 he was appointed Physician-Extraordinary to the Queen, and attended the Prince-Consort in his last illness. In 1862 he became Physician-in-Ordinary to the Queen, and has frequently attended her Majesty. He was made a baronet in 1868, and further advanced to the dignity of a K.C.B. in 1872 for his services during the Prince of Wales’s illness from typhoid fever.

Sir William Jenner has published eminently valuable clinical systematic lectures in the medical journals, and a small treatise on Diphtheria (1861). His addresses to the British Medical Association (1869), and to the Epidemiological Society (1866), published together, are most excellent as summaries of the modern progress of medicine, and as pointing out the directions in which future advances may be made. He insists most strongly on and desires most ardently the prevention of disease, and shows a striking readiness to welcome new discoveries.

Few more striking individualities have been seen among the provincial physicians of our day than that of William Budd, of Clifton. He was one of the younger sons of Mr. Samuel Budd, a successful medical practitioner at North Tawton in Devonshire, who having very considerable culture and foresightedness, brought up most of his large family at home, and was ultimately enabled to introduce seven out of nine sons to the medical profession, sending seven to Cambridge, where five became wranglers. One of the elder brothers, George Budd, was long Professor of Medicine at King’s College, London, the author of an excellent treatise on Diseases of the Liver, and a most successful London physician. William Budd was born in September 1811; his medical studies were pursued in London, Edinburgh, and Paris, in the latter of which cities he spent four years. Graduating M.D. in 1838 at Edinburgh, he for some time afterwards assisted his father in his practice at North Tawton, and here in 1839 commenced his lifelong studies on typhoid fever, having himself been already a sufferer by that malady. He had peculiar advantages in this study, for he was personally acquainted with every inhabitant of the village, and being as medical practitioner in almost exclusive possession of the field, nearly every one who fell ill, not only in the village itself, but over a large area around it, came immediately under his care. At the date of the outbreak the population of eleven or twelve hundred had been extremely exempt from fevers. Yet there was no sewerage system; cesspools prevailed; pig styes were close to the houses; and all conditions of decomposition were to be found;—but fever did not arise till it had been specifically introduced. In July 1839 the first case of typhoid occurred, and before the beginning of November over eighty of the inhabitants had suffered from it. Young Budd kept an accurate and detailed record of every essential fact, and spared no pains in tracing out all extraneous facts that he required to know. He was extremely struck by the fact that three persons left North Tawton after they had been infected, and all three communicated the disease to one or more of the persons by whom they were surrounded. The narrative which Dr. Budd gave many years afterwards, in his “Typhoid Fever: its Nature, Mode of Spreading, and Prevention” (1873), is like a romance for its interesting detail, though melancholy with its tale of pain and death. He shows that there is evidently a specific poison which breeds and multiplies in the living human body, and that this process of breeding and multiplying constitutes the fever itself. This essentially is its contagiousness, the communication from body to body of the specific matter or germ, which when bred and multiplied produces the fever. This he called the master-fact in its history. He further believed that all the emanations from the typhoid patient are in a certain degree infectious, but that what is cast off from the intestine is incomparably more virulent than anything else. Wherever no sufficient provision was made for preventing such material from contaminating the soil and air of the inhabited area around, notwithstanding the most spacious rooms, the freest ventilation, and careful nursing, he found there was no real security against the spread of the fever. The fact alleged against Dr. Budd’s views, that typhoid is seldom taken by attendants on the sick, does not at all militate against his teaching, for unless they received into their system through milk, water, food, or air, some of the specific poison of typhoid, they would certainly not suffer.

In 1842 Dr. Budd settled in Clifton, and was in 1847 elected Physician to the Bristol Royal Infirmary. He lectured for a number of years in the Bristol Medical School, and worked incessantly at maturing and propagating his views on the nature and mode of propagation of zymotic disease. He was no mere theorist, but in all his pursuits had most practical objects in view, seeking to enforce on his medical brethren, public authorities as well as private persons, the urgent necessity of the most careful, well-advised, and continuous methods of disinfection. He was in effect a great sanitarian and champion of preventive medicine. Pure water was one of his great panaceas. The Bristol Waterworks were among his cherished objects of promotion and watchfulness. His remarkable clearness of vision and strength of conviction made him somewhat impatient of the strenuous opposition with which his views were met. For a long period he was almost alone in his uphill fight. He did not fully put his views before the profession till 1857-60, when he published a series of papers in the Lancet, afterwards embodied in his work on typhoid fever; but he had long before taught them in the Bristol Medical School, and practically acted upon them himself. During the depressing period of opposition which he encountered, almost the only sympathy he could count on was that of the late Sir Thomas Watson, who encouraged him greatly, believing his investigations to be of priceless value. Cheered in this way, Budd continued to promulgate his views, dogmatically it is true, but in a manner singularly attractive, for he had a natural kindliness of disposition and freedom from all jealousy. His impressive eloquence was not more striking than his logical power, which is evident in all his works.

Asiatic cholera, when it broke out in Bristol in 1866, found William Budd and Bristol prepared. The deaths from this destroyer in 1849 had been 1979, in 1866 they were but 29, notwithstanding that the disease broke out very severely, and occurred in twenty-six different localities. Budd’s preventive measures, and his stringent plans of disinfection, proved victorious. He made the contagious diseases of animals subjects of special study; and his conclusion was that several of them could only be adequately dealt with by immediately slaughtering the infected animals. This view he took in regard to the terrible rinderpest of 1866: and his advice of “a poleaxe and a pit of quicklime,” though at first ridiculed, had to be followed, after great loss had taken place through not following it earlier.

Dr. Budd was elected a Fellow of the Royal Society in 1870. Besides his famous work on typhoid fever, and many scattered contributions to medical journals and societies, Dr. Budd was the author of the following works, many of which are of very great value:—“Malignant Cholera: its Mode of Propagation and its Prevention” (1849); “Scarlet Fever and its Prevention” (1869); “The Siberian Cattle Plague, or the Typhoid Fever of the Ox” (1865); “On Diseases which affect Corresponding Parts of the Body in a Symmetrical Manner” (1842); “Researches on Gout” (1855); “Cholera and Disinfection, or Asiatic Cholera in Bristol in 1866” (1871); “Variola Ovina—Sheep’s Smallpox—or the Laws of Contagious Epidemics Illustrated by an Experimental Type” (1863). He was an accomplished draughtsman and an excellent photographer, and made great use of these arts in his researches. He was well skilled in French, German, and Italian, and kept himself well up in Continental as well as English medical literature. He worked with untiring energy and industry, having a large practice extending far beyond Bristol: but the attempt to combine this with so much original research proved too much for his constitution. He had been originally strong, but was weakened by two attacks of fever, and finally in 1873 his health broke down, and this led to his finally retiring from practice and settling at Clevedon, where he died January 9, 1880. Just previously to his retirement he had committed to his friend Dr. Paget of Cambridge a brief summary of the results of many years’ study of pulmonary consumption, as to its communicability from person to person by organic germs. This was published in the Lancet at the time, but unfortunately the fuller researches therein referred to have never been given to the public. But in connection with typhoid and other zymotic fevers he has left on the subject the indelible impression of his great genius.

The exertions of Charles Murchison, who died before Budd, though much younger, were largely devoted to controverting Budd’s views on the germ theory of zymotic diseases. He belonged to the same Aberdeenshire family from which Sir Roderick Murchison the geologist sprang, and was born in Jamaica in 1830. His father, himself a physician, spent his latter days in Elgin, where his son Charles was at first educated. As early as 1845 he entered Aberdeen University, but in 1847-8 he commenced medical study at Edinburgh, and in successive years gained numerous distinctions and considerable note as a diligent and successful student. In 1850 he was Syme’s house-surgeon. In August 1857, when he graduated, he received the gold medal for his thesis on the Pathology of Morbid Growths. He further studied at the Rotunda, Dublin, and in Paris, whence he went to India, being appointed Professor of Chemistry to the Medical College, Calcutta. In this office he was both successful as an experimenter and as an expositor. Later, he went with the army on the British Expedition against Burmah, and utilised the opportunity to make valuable observations on the climate and diseases of Burmah, which he afterwards published.

Returning to England in 1855, Murchison became a member of the London College of Physicians, Physician to the Westminster General Dispensary, and Demonstrator of Anatomy at St. Mary’s Hospital. In 1856 he was appointed Assistant-Physician to King’s College Hospital, which office he resigned in 1860, and joined the staff of the Middlesex Hospital. He further held from 1856 the post of Assistant-Physician to the London Fever Hospital, steadily pursuing there as elsewhere his investigations into the nature and causes of zymotic diseases, from which he himself twice suffered in the form of typhus fever, which left in him heart-mischief that ultimately caused his death.

In 1862 appeared Murchison’s work on “The Continued Fevers of Great Britain,” dealing especially with typhus, typhoid, and relapsing fevers. In this he treats exhaustively the history, geographical range, causation, symptoms, treatment, and many other questions connected with fevers, and endeavours especially to reduce his observations to a numerical expression. His strong conviction was that these diseases are preventable, and that they originate in certain unhealthy and impure conditions capable of generating specific poisons in each case. But as he commenced his work at the London Fever Hospital believing that typhus and typhoid fever were mere varieties of one disease, in spite of Stewart’s and Jenner’s publications, so he maintained to the last that Budd’s view as to the germ origin of typhoid fever was erroneous, and that even if typhoid were communicable by germs, it could arise anew when favouring conditions of decomposition occurred. He regarded it as proved that typhoid fever is constantly appearing where decomposing sewage is present, but where every effort fails to detect contamination from a previous typhoid patient.

Murchison’s work was at once recognised as a standard one. The first edition was rapidly sold, and it was translated into German. The publication of a second edition was, however, delayed till 1873, owing to Murchison’s strong desire to make his book as complete statistically as possible. The first edition was based on 6703 cases of continued fever admitted into the London Fever Hospital in the years 1848-57, but the second included the results of a far larger number, 28,863, admitted during 1848-70, thus giving the entire medical history of the fever hospital from the time that the different continued fevers were first distinguished in 1848. Energy and resolution of the most intense description are indicated by such a labour. This work had to be done in the intervals of growing practice and hospital teaching. By the time he was forty years old Murchison was one of the leading London physicians, and continued in full work till his death.

It was not only in regard to fevers that Murchison held a conspicuous place and published works of great value. In 1868 he published an excellent series of “Clinical Lectures on Diseases of the Liver,” which reached a second edition in 1877, when he added to them the Croonian Lectures on “Functional Derangements of the Liver,” delivered at the College of Physicians in 1874. In 1871, when St. Thomas’s new hospital was opened, Murchison was invited to join its staff as full physician and joint-lecturer on medicine. In this growing school he found full scope for his great talent as a clinical teacher. Of his success in this capacity the Lancet said[11]—“His teaching was a reflex of his singular lucidity of thought and expression, which not only attracted the student with its distinctness and brilliancy, but furnished him with a method on which to found his own facts and observations.” His inaugural address as President of the Pathological Society in 1877 gave further proof of his marked originality of thought.

Murchison’s accomplishments and personal attractiveness were as remarkable as his professional talents and industry. In botany, zoology, chemistry, and geology he had very wide knowledge, and he edited the palæontological memoirs of his friend Hugh Falconer, the explorer of the Miocene fauna of the Siwalik Hills. Fly-fishing was his favourite recreation. “In personal appearance,” says the Lancet, “Dr. Murchison was slightly below middle stature, and before the commencement of his fatal illness, of sturdy robust build, with the appearance of one well fitted to bear the trials and struggles of life. His head was large, the forehead high and full, the hair black, and eyes of surprising brilliancy and power of expression. In manner he was reserved, sparing of speech, and free from that impulsiveness which hails the ordinary acquaintances of life as esteemed friends. To those who knew him intimately, however, his full character was revealed, and they found in him a depth of love, tenderness, and sympathy, together with a constancy and devotion in friendship, rarely found in more demonstrative natures.” He attached himself particularly to the younger members of his profession, and never spared time or trouble in assisting them with his counsel and sympathy. He suffered severely from heart disease for several years before his death, which took place suddenly in the interval between the departure of one patient and the announcement of another, on the 23d April 1879.

FOOTNOTES:

[11] Obituary notice, May 3, 1879, p. 645.

[CHAPTER XVIII.]
SIR JOSEPH LISTER AND ANTISEPTIC SURGERY.

Again and again in these pages the hereditary succession of scientific powers has been illustrated. Not the least eminent example is to be found in the case of Sir Joseph Lister, who is the son of Mr. Joseph Jackson Lister, F.R.S., of Upton House, Essex, who in the words of the Rev. J. B. Reade, F.R.S., in his presidential address to the Royal Microscopical Society in 1870, “raised the compound microscope from its primitive and almost useless condition to that of being the most important instrument ever yet bestowed by art upon the investigator of nature.” Mr. J. J. Lister was born in London on January 11, 1786, his parents being members of the Society of Friends. At fourteen years of age he left school to assist his father in the wine trade: but though for many years closely occupied in business, he contrived by early rising and otherwise to supplement his plain school education, and to make himself accomplished in mathematics, as well as generally acquainted with most subjects in literature, science, and art. His predilection for optics was early shown. As a little child with shortsighted eyes, he enjoyed looking through air bubbles in the window-pane, enabling him to see distant objects more clearly. At school he was the only boy who possessed a telescope. He soon became addicted to microscopical study; but it was not till 1824, when he was 38 years old, that he thought of improving the object-glass of the compound microscope, and made suggestions to W. Tulley, the optician, which resulted in the production of a new object-glass much less thick and clumsy, which speedily became the favourite. On January 21st, 1830, he read a paper before the Royal Society “On the Improvement of Compound Microscopes,” announcing the remarkable discovery of the existence of two aplanatic foci in a double achromatic object-glass. This formed a basis for subsequent important improvements. In 1837 he gave to Andrew Ross the construction for a ⅛-inch objective of three compound lenses, by which that maker’s fame was largely increased, and it became the standard form for high power for many years. He also made some notable researches “On the Structure and Functions of Tubular Polypi and Ascidiæ” (Phil. Trans. 1834), and independently came to the same conclusions as Sir George Airy, the late Astronomer-Royal, on the limits of human vision as determined by the nature of light and of the eye; but his paper on this subject was never published, owing to the publication of Sir George Airy’s researches. He survived in vigorous health to see his son Joseph in secure possession of fame, dying on October 24, 1869. His son records[12] that “he was most unselfish, and scrupulously tender of hurting the feelings of others, and extremely generous in the pecuniary support of public philanthropic objects, as well as in secret acts of charity. Though warmly attached to the religious Society of Friends, to which he belonged, he was a man of very liberal views and catholic sympathies. But the crowning grace of this beautiful character, though it might veil his rich gifts from those not intimate with him, was a most rare modesty and Christian humility.”

Joseph Lister was born in 1828, and took the B.A. degree at London University in 1847. Pursuing a course of medical study at University College, London, he gained the M.B. degree in 1852, being awarded gold medals in anatomy and in botany at the first M.B. examination, and the scholarship and gold medal in surgery at the final examination. He became Fellow of the Royal College of Surgeons in 1852, and took a similar qualification at Edinburgh in 1855. He married a daughter of Mr. Syme, then Professor of Surgery in the University of Edinburgh.

Devoting himself to physiological research on matters having a wide bearing on practical medicine and surgery, Mr. Lister attained wide repute as an original investigator at a comparatively early age, and his position in physiology was assured by a series of papers which would suffice to make his career memorable, if he had never applied antiseptic measures to the treatment of disease. Beginning with some observations on the contractile tissue of the iris in 1853, he went on to study the muscular tissue of the skin, the flow of the lacteal fluid, and the minute structure of involuntary muscular fibre, on all of which subjects his papers are published in the “Journal of Microscopical Science.” In 1857 he commenced his series of contributions to the Royal Society, the first being on the functions of the visceral nerves, with special reference to the inhibitory system. This was further developed in “An Inquiry regarding the Parts of the Nervous System which regulate the Contractions of the Arteries” (Phil. Trans. 1858). But his two most important papers at this period are those on the Early Stages of Inflammation (1857), and on the Coagulation of the Blood, delivered as the Croonian Lecture for 1863.

For some years Mr. Lister was a lecturer on surgery in the Edinburgh Extra-Academical School. He was afterwards elected Professor of Surgery in Glasgow University, and Surgeon to the Glasgow Royal Infirmary.

While Mr. Lister held these appointments, circumstances occurred which were calculated to stimulate to the highest degree the effort to discover some method of dressing wounds which should obviate the dangers of putrefactive changes. About 1860 a new surgical hospital was erected as part of this infirmary, and although many of the most approved principles of hospital construction had been adopted, the building proved extremely unhealthy. Pyæmia, erysipelas, and hospital gangrene soon showed themselves, affecting on the average most severely those parts of the building nearest to the ground. For several years Mr. Lister found that in his male accident ward, which was on the ground-floor, when nearly all the beds contained patients with open sores, the diseases which result from hospital atmosphere were sure to be present in an aggravated form; whereas, when a large proportion of the cases had no external wound, these evils were greatly mitigated or entirely absent. At this period the managers were very desirous of introducing additional beds into the wards, to supply accommodation for the rapidly increasing population of Glasgow; and Mr. Lister strongly and firmly resisted such increase in his wards. Some of the wards indeed at times became subject to such severe mortality that they had to be closed for various periods. One particular visitation was so serious that it was resolved to make an investigation to discover if possible the cause of the evil, which might, one would think, have been done at an earlier period. Great was the shock of every one concerned to find that a few inches below the surface of the ground behind the two lowest male accident wards, with only the basement area, four feet wide, intervening, there was the uppermost tier of a multitude of coffins, which had been placed there at the time of the cholera epidemic of 1849. The corpses had undergone so little change in the interval that the clothes they had on at the time of their hurried burial were plainly distinguishable. The wonder was, not that these wards on the ground-floor had been unhealthy, but that they had not been absolutely pestilential. Yet at the very time when this shocking disclosure was made, Mr. Lister was able to state, in an address which he delivered to the British Medical Association at Dublin in 1867, that during the previous nine months, in which his new antiseptic plans of treatment had been in operation in his wards, not a single case of pyæmia, erysipelas, or hospital gangrene had occurred in them.

The managers of the infirmary of course did all in their power to remedy this insalubrious state of things. They poured large quantities of carbolic acid and quicklime upon the ground, considering this a less dangerous proceeding than to attempt the removal of the putrefying mass; they covered the ground with an additional thickness of earth, and adopted other measures. The hospital itself was far from being well situated in other respects. It abutted against the old Cathedral Churchyard, much used for the “pit burial” of paupers in a most deleterious state of aggregation. Yet during the two years and a quarter intervening between the Dublin address and Mr. Lister’s leaving Glasgow for Edinburgh, his new antiseptic system continued in the main as successful as before.

In the course of the year 1864 Professor Lister had been much struck with an account of the remarkable effects produced by carbolic acid upon the sewage of the town of Carlisle, the admixture of a very small proportion not only preventing all odour from the lands irrigated with the refuse material, but also destroying the entozoa which usually infest cattle fed upon such pastures. His attention having been for several years greatly directed, as we have seen above, to the subject of suppuration, especially in its relation to decomposition, he saw that such a powerful antiseptic was peculiarly adapted for experiments with a view to elucidating that subject, and thus the applicability of carbolic acid to the treatment of compound fractures occurred to him.

The antiseptic system was put into practice in the Glasgow Infirmary in March 1865, but at first applied almost exclusively in compound fractures (or those in which there is an external wound) and abscesses. From 1867 it was employed for almost all surgical cases. It arose out of Mr. Lister’s study of Schwann and Pasteur’s germ theory and the experiments connected with them. He repeated many of the experiments, and devised new methods calculated to test whether they were capable of explaining the phenomena of putrefaction. These sufficed to prove definitely that in putrefaction the development of such organisms as the microscope could detect, and the concomitant putrefactive changes, were occasioned by minute germs suspended in the atmosphere. Professor Tyndall’s beautiful experiments, by which he demonstrated the perfect manner in which cotton wool filters the air of its suspended particles, led to the idea (suggested by Dr. Meredith of the Indian service to Mr. Lister) that cotton wool might be used with advantage as an antiseptic dressing. The cotton wool must itself be rendered pure of germs by some antiseptic agency, for by the theory the air within it must contain germs. But the main feature upon which Mr. Lister for a long time relied was the copious use of carbolic acid in such a form as to prevent the occurrence of putrefaction in the part concerned.

Mr. Lister’s first paper on the subject, published in the Lancet for 1867, struck a chord which the editor of that journal emphasised as follows on August 24 of that year (p. 234): “If Professor Lister’s conclusions with regard to the power of carbolic acid in compound fractures should be confirmed by further experiment and observation, it will be difficult to overrate the importance of what we may really call his discovery. For although he bases his surgical use of carbolic acid upon the researches of M. Pasteur, the application of these researches to the case of compound fractures, opened abscesses, and other recent wounds, is all his own.” The risk of blood-poisoning after operations in themselves slight, was declared to be the one great opprobrium of surgery. There was no limit to the operative skill of surgeons, but a miserable and serious risk of fatal after-consequences against which the surgeon had no defence. Mr. (now Sir James) Paget had in 1862 given forth an idea of which we can now more clearly see the bearing, when he said that the best results he had seen in cases of pyæmia were with patients kept night and day in a current of wind. We now see that this in fact amounted to continually passing over the patient air less charged with germs than that of the room or ward in which he was placed. Mr. Lister contemplated the destruction of these germs at the seat of the wound, and the prevention of the access of fresh germs.

An example will perhaps illustrate the matter better than a theoretical account. An experiment was performed on the 31st December 1868 on a young calf a few days old, under chloroform, namely, the tying of the carotid artery on the antiseptic system, with threads composed of animal tissue. The threads employed had all been soaked for four hours in a saturated watery solution of carbolic acid, which swelled and softened them. The hair near the wound was cut short, and a solution of carbolic acid in linseed oil rubbed well into the skin to destroy any putrefactive organisms lying amongst the roots of the hair. The sponges employed in the operation were wrung out of a watery solution of the acid, and all the instruments introduced into the wound, together with the fingers of the operator’s left hand and the copper wire used for sutures, were treated with the same lotion, some of which was poured into the wound after the introduction of the last stitch, at one of the intervals left for the escape of discharge, to provide against the chance of any fresh blood which might have oozed out during the process of stitching having passed back and taken fresh germs in with it. The external dressing was a towel saturated with the oily solution of carbolic acid, folded as broad as the length of the neck, wrapped so as to extend freely beyond the wound, and prevented by several contrivances from slipping. A sheet of gutta-percha tissue was applied outside to prevent contamination of the antiseptic towel from without. A few ounces of the oily solution were poured daily over the towel for the first week, after which the dressings were left untouched for three days and then entirely removed. The wound was found quite dry, and free from tenderness. When the animal was subsequently killed, the ligatures were seen to be converted into living tissue; and such experiments proved how valuable animal fibres might be as ligatures under the antiseptic system.

Again, a portion of cotton wool was impregnated with about one two-hundredth part of its weight of carbolic-acid vapour, and the surface of a granulating sore and surrounding skin was washed with a dilute solution of the acid. A piece of oiled silk of the size of the sore was then applied, to prevent the dressings from sticking through becoming dry. Over this was placed a piece of folded linen rag of rather larger size, and similarly impregnated with carbolic acid vapour to the cotton wool; this being intended to absorb any discharge from the sore. Lastly, an overlapping mass of carbolised cotton wool was securely fixed over all. The result was that although all chemical antiseptic virtue left the dressing by evaporation of the volatile carbolic acid in a day or two, yet putrefaction was practically excluded by the cotton wool for any length of time.

Subsequently another variety of protective material was adopted, namely antiseptic gauze, a loose cotton fabric, the fibres of which were impregnated with carbolic acid lodged in insoluble resin. The interstices between the fibres were kept free from these ingredients, so that the porous fabric might readily absorb discharges. By arranging this in a sufficient number of layers and covering the whole with a layer of mackintosh, the discharge was compelled to pass through the whole length of the antiseptic dressing. Thus it was almost certain that if no putrefactive mischief were left in a wound or abscess, none would enter it, however profuse might be the discharge.

If a wound was presented for treatment, inflicted by some other than the surgeon, some dust was sure to have been introduced, which probably contained putrefactive germs. The energy of these had first to be destroyed by washing the raw surface with some strong antiseptic agent. But in operating upon a previously unbroken skin, Mr. Lister considered that he could prevent the septic particles from entering at all, by operating in an antiseptic atmosphere. This was provided by producing a shower of spray of carbolic acid of the finest character. This answered exceedingly well when the solution producing the spray consisted only of one part of carbolic acid to 100 parts of water.

Here we must limit our detailed account of the antiseptic system. Under it large abscesses are opened, the matter pressed out, and fresh matter does not form, and cures are effected in severe cases which scarcely ever used to be cured. Arteries are tied with a security before unknown. Amputations and excisions are effected with a safety and diminished mortality quite surprising. Even senile gangrene shows hopeful results which were previously quite out of question. Pyæmia, hospital gangrene, and erysipelas have been almost banished from wards where the system is properly carried out. Recently a modification has been introduced, in which there is employed, not a volatile material as in the case of carbolic acid, but a dilute solution of corrosive sublimate combined with albumen. Gauze is now prepared for Sir Joseph Lister steeped in this substance, and it may become generally adopted; but it does not appear likely to supersede carbolic acid for the purification of instruments, sponges, the skin, or as a substitute for the carbolic spray. The particular form of antiseptic is a matter of detail, on which improvement may long continue to be made; but the development of the essential idea of preventing the access of germs which can cause putrefactive changes by one method or another, and the destruction of them as far as possible when they have obtained access, will remain connected with Sir Joseph Lister as an achievement of the highest force; indeed his name seems likely to give a new word to our language, namely Listerism, by which the essential features of his system are understood.

Professor Lister was awarded a Royal Medal by the Royal Society of London in 1880, having previously received the high distinction of the MacDougall Brisbane Prize from the Royal Society of Edinburgh in 1875, for a remarkable paper on the Germ Theory of Fermentative Changes. He was created a baronet in December 1883. The universities of Cambridge, Edinburgh, and Glasgow had conferred upon him the honorary degree of LL.D., and Oxford that of D.C.L. He has been for some years Surgeon to King’s College Hospital, having succeeded Sir William Fergusson.

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.