Title: Eminent doctors: Their lives and their work
Author: Bettany, G. T. (George Thomas)
Language: English
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                           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.

                   [Illustration: Bookmaker’s Mark]

                               LONDON:
                     JOHN HOGG, PATERNOSTER ROW.

                       [_All rights reserved._]




                         CONTENTS OF VOL. II.

  CHAP.                                                         PAGE

  XI. ADDISON, BRIGHT, AND THE DISEASES WHICH BEAR
  THEIR NAMES                                                      1

  XII. LISTON, SYME, LIZARS, AND THE NEWER SURGERY                24

  XIII. BAILLIE, HALFORD, CHAMBERS, AND HOLLAND, THE
  FASHIONABLE AND COURTLY PHYSICIANS                              51

  XIV. SIR WILLIAM FERGUSSON AND CONSERVATIVE SURGERY             71

  XV. SIR JAMES SIMPSON AND ANÆSTHETICS                           83

  XVI. SIR SPENCER WELLS AND OVARIOTOMY                          105

  XVII. SIR WILLIAM JENNER, BUDD, MURCHISON, AND
  TYPHOID FEVER                                                  118

  XVIII. SIR JOSEPH LISTER AND ANTISEPTIC SURGERY                135

  XIX. SIR THOMAS WATSON, SIR DOMINIC CORRIGAN, SIR
  WILLIAM GULL, AND CLINICAL MEDICINE                            148

  XX. SIR JAMES PAGET AND SURGICAL PATHOLOGY                     167

  XXI. WILLIAMS, STOKES, AND DISEASES OF THE CHEST               178

  XXII. SIR HENRY THOMPSON AND CREMATION                         194

  XXIII. GRAVES, HUGHES BENNETT, AND CLINICAL TEACHING           201

  XXIV. CONOLLY, MAUDSLEY, AND MENTAL DISEASES                   217

  XXV. EMINENT SPECIALISTS: SIR ERASMUS WILSON AND
  SKIN DISEASES; MORELL MACKENZIE AND THROAT
  DISEASES; COBBOLD AND INTERNAL PARASITES                       239

  XXVI. EMINENT SPECIALISTS—_continued_: SIR W. BOWMAN,
  BRUDENELL CARTER, AND EYE DISEASES; TOYNBEE,
  HINTON, AND EAR DISEASES                                       260

  XXVII. SIR R. CHRISTISON, SWAINE TAYLOR, AND POISON
  DETECTION       285

  XXVIII. PARKES, GUY, SIMON, AND PUBLIC HEALTH                  295

  INDEX                                                          307




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.


FOOTNOTES:

[13] A most entertaining account of his encounters with a game-cock
is given in Dr. Williams’s “Memoirs of Life and Work,” 1885, from
which most of these particulars are derived.




CHAPTER XXII.

_SIR HENRY THOMPSON AND CREMATION._


The mode of disposing of the remains of the dead is naturally one
upon which doctors may be expected to have a good deal to say. As
guardians of the health of the living, the dangers and diseases
which the material remnants of our deceased friends may occasion the
living must concern the medical profession. The increasingly dense
aggregation of human beings in great towns has impressed the last
two generations with the necessity of doing something to prevent
disease from spreading through delay in burial, and the use of
unsuitable burial-places. But for the most part the efforts which
have been made have only taken the form of pushing the evil a little
further off; and a little mathematical calculation will show that the
present cemeteries must soon be surrounded by habitations, and some
fresh arrangements will have to be made. To cope with these evils
the practice of cremation has been vigorously advocated, as a more
rational and healthy mode of disposing of the dead, by the Cremation
Society, of which Sir HENRY THOMPSON is the President.

This distinguished surgeon is the son of Mr. Henry Thompson of
Framlingham, Suffolk, having been born on August 6, 1820. It is
stated that Mr. Thompson objected to his son’s studying medicine,
believing that the profession had a sceptical tendency. Thus it was
not till he had reached the age of twenty-one, and became entitled
to some property in his own right, that the subject of this chapter
was free to pursue his chosen profession. He studied chiefly at
University College, London, and also in Paris. He obtained the M.B.
degree at London University in 1851, and the Fellowship of the
College of Surgeons in 1853, and in the same year was appointed
assistant-surgeon at University College Hospital. In 1852 and again
in 1860 he won the Jacksonian Prize at the College of Surgeons for
essays on subjects to which he had devoted much of his life-work.

The two works on which Sir Henry Thompson’s reputation among the
medical profession chiefly rests are his “Clinical Lectures on
Diseases of the Urinary Organs,” and his “Practical Lithotomy and
Lithotrity,” both of which have gone through numerous editions;
but he has also written many smaller treatises on allied subjects,
and his articles in Holmes’s “System of Surgery” almost reach the
dimensions of separate works. His practice has grown to large
dimensions in this department, and in 1877 he was able to publish
a list with particulars of 500 cases in which he had performed
operations for stone in the bladder, being he believed the largest
ever published by an operator. The unrivalled extent, also, to which
he was enabled to utilise the experience of other surgeons, by their
communication of their cases to him, made his book on lithotomy and
lithotrity of unique value.

Sir Henry Thompson is known to have made very large use of the
operation devised by Civiale of Paris, in 1817, for crushing
stones into powder or gravel, rendering it unnecessary to perform
the serious operation of lithotomy. Civiale’s first operations of
this kind were performed in 1824, and to him the introduction and
successful application of the method is due. The operation has been
largely improved of late years, and much of this is due to Sir
Henry Thompson. Owing to his well-known skill in this department
of practice, he was called in to the late King of the Belgians in
1863, and succeeded in affording him relief by operation, when the
most distinguished Continental surgeons had failed. The honour of
knighthood was subsequently conferred upon Mr. Thompson by Queen
Victoria in recognition of his great services to her uncle. About
this time Sir Henry became full surgeon to University College
Hospital. He has since relinquished active work at the hospital,
becoming Consulting Surgeon and Emeritus Professor.

Sir Henry has become known to the public in connection with several
important social and religious questions. One which excited much
controversy was his letter to Professor Tyndall in regard to prayer
for the sick, which appeared in the _Contemporary Review_ in 1872.
After classifying the various objects of prayer, and considering
the possibility of testing the actual results of prayer, he says:
“There appears to be one source from a study of which the absolute
calculable value of prayer (I speak with the utmost reverence) can
almost certainly be ascertained. I mean its influence in affecting
the course of a malady, or in averting the fatal termination. For
it must be admitted that such an important influence manifestly
either does, or does not exist. If it does, a careful investigation
of diseased persons by good pathologists, working with this end
seriously in view, must determine the fact. The fact determined,
it is simply a matter of further careful clinical observation to
estimate the extent or degree in which prayer is effective. And
the next step would be to consider how far it is practicable to
extend this benefit among the sick and dying. And I can conceive few
inquiries which are more pregnant with good to humanity when this
stage has been arrived at.”

The practical method proposed for testing the question was that
a single ward or hospital, under the care of first-rate doctors,
containing patients suffering from diseases best understood,
should be made a subject of special prayer by the whole body of
the faithful for three or five years, and that at the end of that
time the mortality should be compared with the past rates, and also
with that of other leading hospitals during the same period. But
the experiment was never tried, owing to the storm of obloquy and
controversy with which the proposal was greeted, in which scant
regard was paid to the evident good faith of the proposer.

Sir Henry Thompson soon came before the public in a new light. Having
failed to get people to pray systematically for the sick, he next
attempted to induce them to burn their dead, a proceeding which,
as it appeared, was little less shocking to many than the former
proposition had proved. The first paragraph of his first article in
the _Contemporary Review_ (January 1874), since reprinted, with a
second on the same subject, struck a sensational key.

“After death! The last faint breath had been noted, and another
watched for so long, but in vain. The body lies there, pale and
motionless, except only that the jaw sinks slowly but perceptibly.
The pallor visibly increases, becomes more leaden in hue, and the
profound tranquil sleep of death reigns where just now were life and
movement. Here then begins the eternal rest.

“Rest! no, not for an instant. Never was there greater activity
than at this moment exists in that still corpse. Activity, but of a
different kind to that which was before. Already a thousand changes
have commenced. Forces innumerable have attacked the dead. The
rapidity of the vulture, with its keen scent for animal decay, is
nothing to that of nature’s ceaseless agents now at full work before
us.”

After explaining the process of animal decomposition, and describing
the various modes of disposing of the dead between which it is
necessary to choose, the writer went on to insist that our present
mode of burial is certainly injurious to health either now or in
the future, and constitutes in reality a social sin of no small
magnitude. A curious aspect of this question was brought to light by
the mention of the large annual importation of bones for manuring
the soil, while we bury a vast quantity of human bones annually, too
deep in the earth to be useful agriculturally. The evils of burial
customs and expenditure were also dwelt upon, and then the new, yet
old plan of cremation was advocated, practically following nature’s
indication, and hastening the process so as to make it safe, without
unpleasantness. It was suggested that funeral rites could be most
appropriately associated with cremation. “Ashes to ashes, dust to
dust” would express a literal and evident fact. The condition of many
churchyards, past and present, has given conclusive evidence that the
present mode of burial consigns moist remains to water or damp, and
generates loathsome effluvia, too often causing severe disease in
those living near.

This subject is still one of controversy, though it has emerged into
“practical politics” by reason of a decision by Mr. Justice Stephen
that cremation is not illegal under the present law. Sir Henry
Thompson continues his vigorous efforts in favour of cremation.

Sir Henry has also distinguished himself as an advocate for great
moderation and even total abstinence in the use of intoxicating
liquors, stating that without them he can do his work better and with
more zest, and that his constitution has improved under abstinence.
Among his lighter works, “Food and Feeding” is pleasant and popular;
while a still later display of varied literary tastes is seen in
a medical novel, “Charley Kingston’s Aunt,” published under the
pseudonym of Pen Oliver.

The artistic tastes and attainments of Sir Henry Thompson are
well known. He studied painting under Elmore and Alma Tadema,
and has frequently exhibited at the Royal Academy. He has a very
fine collection of blue and white Nankin china, of which a quarto
catalogue has been published.




CHAPTER XXIII.

_GRAVES, HUGHES BENNETT, AND CLINICAL TEACHING._


The subjects of this chapter, both men of great influence, left a
decisive mark on the systems of clinical teaching in their respective
schools of medicine, besides rendering great services to physiology
and to medicine.

In Dublin University a Regius Professorship of Physic dates from the
time of the Restoration, and other chairs were subsequently founded.
The Irish College of Surgeons was established as late as 1784, but
nothing great came of it for many years. A Scotchman, Cheyne, settled
in Dublin, published in 1817 the first volume of the Dublin Hospital
Reports, and by the excellence of his own clinical reports on cases
of fever, gave a good tone to the work of the Irish school. But the
elevation of the Dublin Medical School to the high rank which it has
ever since maintained was the work emphatically of Robert Graves and
of William Stokes.

The Graves family, descended from a colonel in Cromwell’s cavalry,
who had acquired considerable estates in Limerick county after
Cromwell’s subjugation of the country, was represented at the close
of the last century by the Regius Professor of Divinity in Dublin
University, and one of the senior Fellows of Trinity College, Richard
Graves, D.D. His three sons, Richard, Hercules, and Robert obtained
at the degree examinations of three successive years the gold medal
in science and in classics.

ROBERT JAMES GRAVES, born in 1795 or 1796, after going through
a complete arts course, and such medical study as Dublin then
afforded, graduated M.B. at Dublin in 1818. He then betook himself
to other schools, and successively studied in London, in the most
celebrated Continental schools, and in Edinburgh, being away from
Dublin more than three years. He had an excellent language-faculty,
and once, having forgotten his passport, was imprisoned for ten
days in Austria as a German spy, the authorities insisting that no
Englishman could possibly speak German as he did. During his stay in
Italy, Graves, who had considerable artistic capacity, accidentally
made the acquaintance of Turner, the celebrated painter, and became
his companion on many journeys. An interesting notice of Graves’
intercourse with Turner has been given by Professor Stokes.[14] It
appears that the two lived and travelled together for months without
either of them inquiring the name of his companion.

On a voyage from Genoa to Sicily Graves’ courage and decision were
strikingly put to the test when the captain and crew, in a terrific
gale, were about to quit the ship in the only boat, leaving the two
passengers to their fate. Graves, though ill, seized an axe, and
stove in the boat, took command, repaired the pumps from the leather
of his own boots, and saved the ship.

In 1821 Graves returned to Dublin, and at once took a leading
position. Dr. Stokes, for a short time his pupil, and his lifelong
friend, says of him at this time: “Nature had been bountiful to
him: he was tall in stature, of dark complexion, and with noble and
expressive features. In conversation he possessed a power rarely met
with; for while he had the faculty of displaying an accurate and
singularly varied knowledge without a shade of egotism, he was able
to correct error without an approach to offence. He had at once a
warm and a sensitive heart, and ever showed lasting and therefore
genuine gratitude for the smallest kindness. Loving truth for its
own sake, he held in unconcealed abhorrence all attempts to sully or
distort it; and he never withheld or withdrew his friendship from
any, even those below him in education and social rank, if he found
in them the qualities which he loved, and which he never omitted to
honour.”

“It is to be observed that as his mind was open and unsuspicious,
he occasionally fell into the error of thinking aloud without
considering the nature of his audience, and of letting his wit play
more freely, and his sarcasm, when defending the right, cut more
deeply than caution might dictate.”

During the year 1821 Graves was elected physician to the Meath
Hospital, and also became one of the founders of the Park Street
School of Medicine. At this time clinical investigation and clinical
teaching could scarcely be said to exist, and the pathological
studies of other schools were rather held in contempt. The methods
in vogue in Edinburgh had not impressed Graves favourably. Students
were not then regularly called upon to investigate cases for
themselves, nor trained in so doing: they might obtain their degree
without having ever practised diagnosis or co-operated in curing
disease even to the extent of writing a prescription. “Often have
I regretted,” said Graves in his introductory lecture at the Meath
Hospital in 1821, “that, under the present system, experience is only
to be acquired at a considerable expense of human life. There is,
indeed, no concealing the truth—the melancholy truth, that numbers of
lives are annually lost in consequence of maltreatment. The victims
selected for this sacrifice at the shrine of experience, generally
belong to the poorer classes of society, and their immolation is
never long delayed when a successful candidate for a dispensary
commences the discharge of his duty. The rich, however, do not always
escape; nor is the possession of wealth in every instance a safeguard
against the blunders of inexperience.”

After commenting on the evil effects of ignorant dogmatism in those
of riper years, Dr. Graves went on to expound the plan of Continental
clinical instruction. He then alluded to the coarse, harsh, and even
vulgar expressions made use of towards hospital patients by Irish
medical men of the day, insisting on the necessity of reform in this
respect.

The plan that Graves adopted and worked so successfully, essentially
consisted in giving to the advanced students charge over particular
patients, requiring them to report upon the origin, progress, and
present state of their diseases. At the bedside these particulars
were verified or challenged by the physician; and then in the
lecture-room he discussed with the class the diagnosis, prognosis,
and treatment of the cases. The pupil in charge prescribed for the
patient, and his prescription was revised and corrected by the
physician. The advantages of this system were obvious; students being
obliged to give reasons for every plan of cure, became accustomed
to a rational and careful investigation of disease, and enjoyed the
great benefit of the early correction of their errors.

Nevertheless the system met with much opposition, and even ridicule.
As Stokes says, the student was then kept at a distance; no one cared
to show him how to teach himself, to familiarise him with “the ways
of the sick,” to train his mind to reason, and to inculcate the duty
as well as the pleasure of original work.

Graves had both knowledge and eloquence; his style was massive,
nervous, and forcible; he could command the minds of his hearers,
and he showed himself thoroughly in earnest. “His active mind
was ever on the search for analogies, and thus he was led to the
discrimination of things apparently similar, and to the assimilation
of things at the first view dissimilar, in a degree hardly surpassed
by any teacher of medicine.”

Having been elected a Fellow of the King’s and Queen’s College of
Physicians, Graves was subsequently appointed Professor of the
Institutes of Medicine. In this capacity he gave lectures in which
physiology was ably applied to the wants of medical students. In
the years 1828-36 he contributed many physiological essays, chiefly
to the _Dublin Journal of Medical Science_, of which he was one of
the editors till his death, on such subjects as “The Distinctive
Characters of Man,” “The Chances of Life,” “Temperament and
Appetite,” “The Sense of Touch,” &c., all interesting. But it was
not till 1843 that he published the work on which his reputation as
an author chiefly rests, his “Clinical Lectures on the Practice of
Medicine.” In relation to this one needs no higher authority in its
favour than that of Trousseau, who addressed to the translator of the
French edition a letter from which we make the following extracts.

“I have constantly read and re-read the work of Graves; I have become
inspired with it in my teaching.... The lectures on scarlatina,
paralysis, pulmonary affections, cough, headache, have acquired
an European reputation.... When he inculcated the necessity of
giving nourishment in long-continued pyrexias, the Dublin physician,
single-handed, assailed an opinion which appeared to be justified
by the practice of all ages, for low diet was then regarded as an
indispensable condition in the treatment of fevers. Had he rendered
no other service than that of completely reversing medical practice
upon this point, Graves would by that act alone have acquired an
indefeasible claim to our gratitude.”

“On the other hand, I cannot sufficiently recommend the perusal
of the lectures which treat of paralysis; they contain a complete
doctrine, and this doctrine has decisively triumphed. The sympathetic
paralyses of Whytt and Prochaska have now their place assigned in
science, under the much more physiological name of reflex paralyses.”

“Graves is a therapeutist full of resources.... There is not a day
that I do not in my practice employ some of the modes of treatment
which Graves excels in describing with the minuteness of the true
practitioner, and not a day that I do not, from the bottom of my
heart, thank the Dublin physician for the information he has given
me.”

“Graves is in my acceptation of the term a perfect clinical teacher.
An attentive observer, a profound philosopher, an ingenious artist,
an able therapeutist, he commends to our admiration the art whose
domain he enlarges, and the practice of which he renders more useful
and more fertile.”

In 1843 and 1844 Graves was President of the Irish College of
Physicians, and was elected a Fellow of the Royal Society in 1849. He
was led by his experience to hold strongly the belief that typhus and
typhoid were not distinct fevers. His great service to the treatment
of fevers is however independent of this. He recognised the ill
effects of a lowering system upon fever patients, and steadily set
himself to maintain the patient’s strength by food and stimulants.
One day he was going round the hospital, when on entering the
convalescent ward he began to expatiate on the healthy appearance of
some who had recovered from severe typhus. “This is all the effect
of our good feeding,” he exclaimed; “and lest, when I am gone, you
may be at a loss for an epitaph for me, let me give you one, in three
words:—

  “HE FED FEVERS.”

Graves’s papers on Cholera embodied in his Clinical Lectures give
an able history of the progress of that disease, and his researches
led him to urge the foundation of a complete network of medical
observatories to record especially the rise, progress, and character
of disease, whether endemic or epidemic. Had he lived he might have
done much to promote this object, only now and partially being
attempted in the collective scheme for the investigation of disease
under the auspices of the International Scientific Congress. But his
labours shortened his life. He constantly corresponded with pupils
all over the world; wrote much for periodical literature on subjects
outside medicine, even doing the literary work of a patient whose
family were in straitened circumstances. A disease of the liver
finally cut him off, after a protracted illness borne with Christian
fortitude and faith, on March 20, 1853.

       *       *       *       *       *

Having been a leading teacher at Edinburgh for many years, JOHN
HUGHES BENNETT impressed his individuality upon a larger number of
students, and has been more generally recognised than Graves as a
man of conspicuous merit. As a clinical teacher, as a physiologist,
as a pathologist, as a therapeutist, he had high claims. He reformed
the treatment both of pneumonia and of phthisis, and identified
a disease, leucocythæmia, whose characters have proved the
starting-point for most fruitful investigations.

Bennett was born in London on August 31, 1812, and educated at the
Grammar and Mount Radford Schools, Exeter. He was fortunate in having
a cultivated mother, a lady of independent thought and spirit, and
to her he owed the development of his marked literary and artistic
tastes. As a boy she trained him in elocution, in which he afterwards
excelled, and widened his thoughts by taking him again and again to
the Continent.

Deciding to study medicine, young Bennett was apprenticed to a
Mr. Sedgwick of Maidstone, and for a short time attended St.
Bartholomew’s Hospital. A little later, however, he decided to
enter at Edinburgh University, and soon showed himself an assiduous
student. He made the acquaintance of Edward Forbes, J. H. Balfour,
John Reid, and others, who afterwards distinguished themselves,
and became one of the Presidents of the Royal Medical Society. In
1837 he took the M.D. degree, being awarded a gold medal, on Syme’s
recommendation, for the best surgical report, and being mentioned as
worthy of a second medal by Sir Charles Bell.

Bennett next studied for two years in Paris, founding the Parisian
Medical Society, of which he was the first president. Other two years
he devoted to study in German medical schools. The microscope and the
stethoscope became in his hands familiar implements of research, and
he already began to give forth the results of his study, contributing
to Tweedie’s “Library of Medicine” a large proportion of the second
volume dealing with diseases of the nervous system.

Bennett returned to Edinburgh in 1841, and on the 1st October
published “Treatise on the Oleum Jecoris Aselli, or Cod-liver Oil,
as a Therapeutic Agent in certain Forms of Gout, Rheumatism, and
Scrofula, with Cases.” His knowledge of this remedy had been acquired
in Germany, where cod-liver oil was being used in the treatment
of these diseases. Its use had however long been known among the
Scotch fishing folk, and Drs. Kay and Bardsley had many years
before prescribed it in the Manchester Infirmary. The publication,
however, stagnated, and there was added in 1847 to the remaining
copies an appendix of cases benefited by cod-liver oil. By this time
its administration was decidedly on the increase, and one firm of
druggists in Edinburgh had sold six hundred gallons in the preceding
year, as compared with one gallon in 1841. At the same time Dr. C. J.
B. Williams was introducing purer forms of the oil in London, as we
have already related, and by his writings and practice and study of
cases of pulmonary consumption did very much to promote its general
use.

In November 1841 Bennett started a course of lectures on histology
at Edinburgh, in which he illustrated physiology and pathology by
microscopical preparations: he also formed classes for private
instruction in microscopical manipulation. At that time minute
changes in structure were generally overlooked, and to Bennett
belongs the credit of first giving such instruction in a systematic
form. He strongly desired to gain the chair of General Pathology at
Edinburgh, which was vacant in 1842, but he was unsuccessful.

When he was soon afterwards appointed physician to the Royal
Dispensary, Bennett had an opportunity of putting into practice
what he had learnt in Germany, by establishing what he called a
polyclinical course, his students being taught practically, under
the eye of the teacher, to examine and prescribe for patients. It
must not be forgotten, however, that Syme had previously introduced
a somewhat similar procedure at his Minto House (Surgical)
Hospital. As Pathologist to the Royal Infirmary, Bennett had great
opportunities of studying morbid specimens, and he got together a
large pathological collection. He further gave courses of lectures on
pathology.

For many years Bennett took a large part in maintaining the literary
activity of the Edinburgh School. Many papers by him appeared in the
_London and Edinburgh Monthly Journal of Medical Science_, of which
he subsequently was part and sole proprietor two or three times,
being so lucky as to make a profit on each of his transactions.

In 1848 Dr. Bennett was unanimously elected Professor of the
Institutes of Medicine (_i.e._, Physiology) at Edinburgh. In this new
work he was soon conspicuous for the practicality of his teaching,
and for his continual introduction of matters bearing on pathology
and medicine. He made every lecture a complete study, enriching
it with all the appliances, material and artistic, that he could
command, and embellishing it by finished elocution. He would now
and again lay aside his manuscript to comment upon, and frequently
to denounce, the opinions of others, by which course he made
enemies, for he was not sufficiently measured in his treatment of
opponents. Yet it might safely be said that he was not actuated by
personal hostility, but only by antagonism of view. Still he was too
favourable to his own work, and did not adequately appreciate other
men. The general student enjoyed those peculiarities of Dr. Bennett
of which he did not himself feel the brunt, but in the clinical
class or in the examination hall his unsparing logical acumen tasked
the student mind somewhat severely, and he was a generally dreaded
examiner.

From the peculiar organisation of Edinburgh work Bennett was expected
to be a clinical teacher of medicine as well as a professor of
physiology; thus the importance of his work in the infirmary was as
great as that in the lecture-room. He was a clinical teacher of the
highest order—nothing was suffered to pass unnoticed. All methods
of inquiry into the patient’s case were diligently taught to the
students, who were led to observe precisely and methodically for
themselves. He would test and stimulate his pupils[15] most acutely
by disputation, questioning, and argument; and he thus trained a body
of men who carry his impress into all their work.

In 1845 Dr. Bennett published a case of “Hypertrophy of the
Spleen and Liver,” which is the first recorded case of a disease
characterised by a great abundance of white corpuscles in the blood,
now known as leucocythæmia. Although Bennett did not at first
recognise its true nature, his description and subsequent labours
did much to elucidate the disease, and his name must be honourably
associated with the subject.

Perhaps, however, the greatest service Bennett rendered to medicine,
independently of his promotion of the use of cod-liver oil in
phthisis, is his strong protest against the lowering treatment in
pneumonia and other inflammatory diseases. On this point the _Lancet_
(October 9, 1875) says: “He reduced the mortality of uncomplicated
pneumonia to _nil_. He demonstrated, not only the dispensableness,
but the injuriousness, of the antiphlogistic treatment which had
ruled the best minds of the civilised world for ages. Doubtless other
physicians were working in the same direction even before Bennett,
but he devised a treatment of his own which has given most brilliant
results, and he adhered to it and to the pathological views on which
it was based so steadily and over so long a series of years as to
establish its truth, and so largely revolutionise the practice of
medicine in acute diseases.” Dr. Bennett’s later attacks on the
mercurial treatment of liver diseases were almost equally strong with
that on bleeding and the antiphlogistic methods, but being undertaken
late in life did not leave such an impression.

Dr. M’Kendrick gives in the _British Medical Journal_, October 9,
1875, a list of no fewer than 105 papers and memoirs by Bennett.
Among his larger works were “An Introduction to Clinical Medicine;”
“Lectures on Clinical Medicine,” 1850-6, which were entitled in
later editions “Clinical Lectures on the Principles and Practice
of Medicine.” Of this his principal work, six editions were
published during his lifetime in the United States, and the book
has been translated into French, Russian, and Hindoo. “Outlines
of Physiology” appeared in 1858, and a Text-book of Physiology in
1871-2. His works on Cancerous and Cancroid Growths, on the Pathology
and Treatment of Pulmonary Tuberculosis, and on the Restorative
Treatment of Pneumonia, will of course be consulted as containing
authoritative statements of his views on these important subjects.
He wrote the article on Phthisis in Reynolds’ “System of Medicine,”
Reports on the Action of Mercury on the Liver, and Researches on
the Antagonism of Medicines, as reports to the British Medical
Association, 1867-1875.

Dr. M’Kendrick, some time Bennett’s assistant and deputy, says of
him:[16] “Professor Bennett was a man of clear and logical intellect.
What he wanted in breadth of view he gained in penetrative power. Few
could grasp more quickly the essentials of a subject, or perceive
sooner or more accurately the real point at issue. _Method_ was the
prevailing quality of his mind which guided him as a teacher....
He wanted patience with details, the power of positive scientific
expression, and the faculty of taking a wide view of all the facts
bearing on what was immediately under discussion. He assumed an
attitude of scepticism to all questions until fairly convinced.”

“His tendency to indulge freely in critical and sarcastic remarks
upon the works of others did not make him a general favourite with
some of his professional brethren, consequently he never attained
a large practice as a consulting physician, which was from other
considerations his due. He was too much a reformer, too pronounced
and outspoken in his opinions; he had too much identified himself
with certain lines of thought; and it must be confessed that he did
not possess that indefinable manner which inspires confidence both in
patient and in practitioner alike.”

“By those who knew him best Dr. Bennett was much beloved. He shone
in the social circle, where his love of music and power of brilliant
conversation cast a radiance through the room.”

In 1855 Bennett unsuccessfully competed for the chair of the Practice
of Physic at Edinburgh, and he felt his non-success very much. For
the next ten years he continued in active work, but in 1865 began
to suffer severely from a bronchial and throat affection. Later he
was attacked by diabetes, and had to spend several winters on the
Continent. In 1874 he resigned his professorship. In August 1875 he
was gratified by receiving from Edinburgh the LL.D. degree, his bust
by Brodie being presented to the University by former pupils. He
was operated on for stone in September following at Norwich, by Mr.
Cadge, and died on September 25th, being buried at Dean Cemetery,
Edinburgh, by the side of his friends, Goodsir and Edward Forbes. His
wife, son, and four daughters survived him.


FOOTNOTES:

[14] Biographical Notice, prefixed to Graves’ “Studies in Physiology
and Medicine,” 1863.

[15] _Edinburgh Medical Journal_, October 1, 1845.

[16] _Edinburgh Medical Journal_, November 1875, p. 473. See also
_British Medical Journal_, October 9th, 1875.




CHAPTER XXIV.

_CONOLLY, MAUDSLEY, AND MENTAL DISEASES._


The modern realisation of the association of mental with physical
health, the annexation to the sphere of biology of the phenomena of
mind, and the concurrent comprehension of the true attitude of the
physician towards mental diseases, have doubtless put into the shade
achievements less than a century old, and some of them dating from
only fifty years ago. Yet the simple discontinuance of the system of
restraint practised from time immemorial on almost all lunatics was
perhaps a greater practical revolution than the biological one just
referred to; and England stands in the forefront of this revolution.

The old lunatic asylums of this country were objects of dread and
repulsion. Severity was considered to be an absolute necessity in
their management. “The affrighted visitors,” says Conolly,[17]
“saw that many were furious ... and it never occurred to them that
habitual severity was the real cause of the habitual fury.” New
Bethlem in Moorfields two centuries ago was a place of chains,
manacles, and stocks. Down to 1770 the inmates were exhibited to the
public at a charge of twopence, afterwards reduced to one penny.

The medical profession had become accustomed to neglect mental
diseases, and to acquiesce in severe treatment. Cruelty became
developed in ingenious forms. In some Continental asylums patients
were terrified by the gradual ascent of water in a well in which
they were chained. Machines were imagined by which a newly arrived
lunatic could suddenly be raised to the top of a tower, and as
suddenly lowered into a deep dark cavern; “if the patient could be
made to alight among snakes and serpents, it would be better still.”
A revolving chair was invented, in which the victim could be strapped
and made to gyrate at the rate of one hundred revolutions per minute.
This was eulogised as a potent means of quieting the unmanageable,
and was supposed to induce the melancholy to take “a natural interest
in the affairs of life.” We can only make this passing allusion to
the way in which ingenuity was exhausted in devising methods of
restraint and torture.

Nothing could have been worse than the condition of the Bicêtre and
the Salpêtrière, the two large asylums of Paris, when Pinel was in
1793 appointed to the former by Cousin, Thouret, and Cabanis, then
newly appointed administrators of the Parisian hospitals. Damp,
dark cells, infested by rats, contained dirt-coated beings whose
only comfort was a little straw, chained, brutally ill-treated,
and attended by brutal criminals. For nearly ten years previously
Pinel’s attention had been directed to the treatment of the insane,
and now, in spite of difficulties which officials threw in his way,
he succeeded in loosening the chains and ameliorating the treatment
of the majority of the patients. Yet his reforms nearly cost him
his life. Rumours were spread accusing him of some evil motive in
unchaining dangerous lunatics, and a mob one day seized him, and
uttered the well-known terrible cry “_à la lanterne!_” An old soldier
of the French Guard, once a lunatic, whom he had released from
chains, cured, and employed in his own service, was appropriately the
means of his rescue. Thus was philanthropy once more justified of her
children.

At this very period English public opinion had been excited by
revelations of cruelty and consequent deaths in the old York Asylum.
In 1791 a lady belonging to the Society of Friends was placed in
this asylum; her friends were refused admission to visit her, and in
a few weeks she died. Inquiries that were made showed great grounds
for suspicion, although full details could not be obtained.[18] But
with great promptitude William Tuke, a prominent Friend at York,
whose family has continued famous for attention to the affairs of the
insane, proposed early in 1792 the establishment of a “Retreat” at
York for insane patients, in which sympathy should be substituted
for unkindness, severity, and stripes. The account given by Samuel
Tuke in 1813 of its management is still a model in many respects.[19]

Neither Pinel nor the Tukes were however bold enough entirely to
dispense with mechanical coercion. In 1818 Esquirol, the true
successor of Pinel in France, found maltreatment still generally
prevalent in the provincial asylums of France. In England mechanical
restraint continued to be largely employed till Conolly’s time,
and survives in some private asylums to the present day. We cannot
give further details on this head, but hasten to mention the names
of two men, Dr. Charlesworth and Mr. Gardiner Hill, who must ever
be remembered as the first to give up mechanical coercion entirely
in the small asylum of Lincoln. Dr. Charlesworth, physician to
the asylum, had for many years diligently watched the effects of
mechanical coercion, and gradually lessened the number of instruments
of restraint in the asylum. Finally, the total disuse of mechanical
restraints was decided on, and put in practice by Mr. Gardiner Hill
in 1836 in concert with Dr. Charlesworth, with the most gratifying
results.

       *       *       *       *       *

We now come to the man who more than any other in England may be
said to have established the non-restraint system so firmly that
it will never be upset. JOHN CONOLLY was born at Market Rasen in
Lincolnshire, in 1794. His father, a member of a good Irish family,
died young, and the care of a young family fell on his widow, whose
maiden name was Tennyson, and whose patience and self-sacrifice
her son ever affectionately acknowledged as the main influence
which led to his own success. When his mother ultimately married a
French gentleman, a political emigré, the latter taught his stepson
French, and imbued him with a genuine taste for and knowledge of
the language. Condillac’s essay “On the Origin of Human Knowledge”
influenced his mental life. While in his teens his attention was
first called to the subject of lunacy by an inspection of the Glasgow
Asylum, and he never afterwards ceased to take the deepest interest
in it.

At eighteen young Conolly became an officer in a militia regiment,
in which capacity he served several years. While still young, he
married in 1816 the daughter of Sir John Collins and went to reside
in France, on the banks of the Loire. A year later he had decided
to enter the medical profession, and in 1817 became a student at
Edinburgh University. After a diligent career, in the course of
which he was one of the presidents of the Royal Medical Society, he
graduated M.D., and settled in practice as a physician at Chichester.
Here he became intimately acquainted with Dr. (afterwards Sir John)
Forbes, with whom he was afterwards much connected in literary
matters.

Dr. Conolly did not remain very long at Chichester, but removed in
1823 to Stratford-on-Avon, where he wrote many contributions to and
took part in editing the “Cyclopædia of Practical Medicine,” and the
_British and Foreign Medical Review_. At Stratford he became alderman
and mayor, established a public dispensary, and studied Shakespeare
with enthusiasm. This occasioned him afterwards, while practising at
Warwick in 1835, to take an active part as chairman of the committee
formed for securing the preservation of Shakespeare’s tomb, and the
restoration of the chancel of the church.

In 1827 Dr. Conolly was appointed Professor of the Practice of
Medicine in London University, which appointment he only held four
years, finding life as a London physician unsuitable to his tastes.
In 1831 he again resorted to the country, establishing himself in
Warwick.

The subject of insanity had long engaged Dr. Conolly’s attention. He
had studied the question both abroad and at home, and had been for
five years, (while residing at Stratford) inspecting physician to the
Lunatic Houses for the County of Warwick, an office which he resumed
when he settled in Warwick. He had unsuccessfully proposed to the
council of the University that he should give his pupils clinical
instruction on insanity in one of the lunatic asylums in London.
“Thus,” says Sir James Clark,[20] “clinical instruction in mental
diseases was thrown back for thirty years in this country.”

In 1830 Conolly published his valuable work, “An Inquiry concerning
the Indications of Insanity, with Suggestions for the better
Protection and Care of the Insane.” His objects were to render
the recognition of insanity less difficult, by showing in what it
differed from those varieties of mind which approached nearest to it;
and to point out those circumstances which, even in persons decidedly
insane, could alone justify various degrees of restraint. He lamented
that during a student’s career he only saw cases of insanity by
some rare accident. Every lunatic asylum was closed to him, and
yet when qualified he might any day have to decide on a patient’s
insanity. In view of some recent revelations a quotation from the
introduction to this work (p. 3) is not inappropriate. “The timidity
or ignorance, or it may be, a dishonest motive, of relatives, leads
to exaggerated representations; and the great profit accruing from
a part of practice almost separated from general medicine, cannot
but now and then operate against proper caution in admitting such
representations. When men’s interests depend upon an opinion, it is
too much to expect that opinion always to be cautiously formed, or
even in all cases honestly given. The most respectable practitioners
in this department openly justify the authorising of restraint before
the patient is seen, and on the mere report of others; and it seems
that depositions to the insanity of individuals have been received
in courts of law, concerning persons with whom the deponents have
never had an interview; and that on these depositions proceedings
have been partly founded, of which the results were the imprisonment
of lunatics, and restraint over their property. When the affair is
conducted with more formality, and the suspected person is visited
before being imprisoned, those who visit him are often very little
acquainted with mental disorders, and come rather to find proofs of
his insanity, which, to minds pre-possessed, are seldom wanting, than
cautiously to examine the state of his mind.”

“If a person of sound mind were so visited, and knew of the visit
beforehand, it would not be quite easy for him to comport himself,
so as to avoid _conviction_ that he was _not_ of sound mind. His
indignation would pass for raving; his moderation for the proverbial
cunning of a lunatic.”

After describing the condition of asylums and lunatics at that time,
the author considers the constitution of the human understanding and
the inequalities, weaknesses, and peculiarities of mind which do not
amount to understanding, and the influence of stimuli, of age, and
of disease on the mind, and then discusses the phenomena of insanity
and the questions of treatment and protection. He insists on the
necessity of the most scrutinising watchfulness over the servants
employed in their care. In cases where patients would do themselves
or others an injury he insists on watching, instead of mechanical
means of restraint. He proposes a complete scheme for the care of all
lunatics by the State, providing for perfect publicity of procedure.
He finally points out the increasing liability of the nervous system
to disorganisation owing to the increased pressure and more varied
anxieties of modern life, an observation most fully justified by what
has been established since his day.

This work, a most readable and interesting one, both to medical men
and to general readers, was not received with nearly sufficient
warmth. Too many were wedded to the old systems of treatment; too
many knew nothing about the diseases of the mind, and their sympathy
could not be aroused in favour of lunatics. So Conolly was left
to his country work at Warwick, varied by one year’s residence at
Birmingham, till 1839, when he was appointed Resident Physician to
the Middlesex County Asylum at Hanwell, at that time the largest in
England. He had taken the opportunity of visiting the Lincoln Asylum
and gaining all the advantages possible from its experience. He was
now satisfied that mechanical restraint was not only unnecessary, but
possibly injurious. On few others had the non-restraint system gained
a hold. Hanwell had the reputation of being one of the best-managed
asylums in England, many patients being occupied in agricultural and
other pursuits. Yet one year after Sir William Ellis’s resignation,
when Conolly took office, “instruments of mechanical restraint of
one kind or other were so abundant in the wards as to amount, when
collected together, to about six hundred, about half of them being
handcuffs and leg-locks.”

Conolly entered upon his duties on the 1st June 1839. The asylum
then contained 800 patients, and he found forty under continuous
mechanical restraint. In his first report to the Quarter Sessions,
he informed the Justices that since the 21st of September not one
patient had been under restraint. “No form of strait waistcoat, no
handcuffs, no leg-locks, nor any contrivance confining the trunk, or
limbs, or any of the muscles, is now in use. The coercion chairs,
about forty in number, have been altogether removed from the wards.”
In fact, they had been cut up to make a floor for the carpenter’s
shop.

This was not accomplished without some trouble and anxiety. It took
time to indoctrinate the officers and attendants with the principles
of the new system, in which they were deprived of their old prop. The
aid which he received from Miss Powell the matron was most valuable.
In ten years not one case was admitted to Hanwell in which mechanical
restraint was deemed necessary, although many suicidal patients were
among them. In fact, the removal of restraint tended directly and
powerfully to promote the recovery of these, by taking away the sense
of degradation occasioned by such restraint, by bringing them within
the sphere of medical remedial agents and of cheerful influences. The
only substitutes allowed were in some cases seclusion of a patient in
an ordinary sleeping apartment, and, in extreme cases, in a padded
room in which the floor was a bed; such seclusion being immediately
reported to the medical officers, and recorded, even when continued
only for a few minutes. This was found sufficient to protect the
other patients, to calm the refractory one, and act as a tonic and
remedial influence. The shower-bath was rarely resorted to except
for medical reasons; window-guards, clothing, and bedding of strong
materials to prevent tearing, were only required in a few cases. “The
great and only real substitute for restraint is invariable kindness,”
says Dr. Conolly. “This feeling must animate every person employed in
every duty to be performed.”

Dr. Conolly published the main results of his experience in his
Clinical Lectures in the _Lancet_ in 1846, and in a work on the
Construction and Government of Asylums, in 1847. His annual reports
to the Justices detailed the progress of his system, and he
afterwards summarised them and published them collectively. At the
end of ten years, finding the non-restraint system in no danger
of being abandoned at Hanwell, Dr. Conolly ceased to be resident
physician, and became visiting physician, attending at the asylum
twice a week, and spending the greater portion of the day there. His
interest in the patients, says Dr. Hitchman, seemed never to flag.
He would always look out for something to commend in a patient, the
hair better kept, clothes more neatly worn, &c., and addressing the
patients in the most gentle, affectionate tones, he made his visits
always a matter of longing. The old attendants at the hospital in
after years spoke of Dr. Conolly’s untiring watchfulness in the first
years of his experiment. He would visit the wards at all hours of the
night to see that his orders were being obeyed, walking noiselessly
along the corridors. He was kept up in his arduous duties by an
elevated religious principle. “I feel grateful to God,” he wrote,
“who has intrusted duties to me which angels might stoop to perform.”
He suffered greatly from an affection of the skin, which kept him
awake at night and ill at ease during the day; and hence was liable
to fits of depression and irritability which sometimes made him
appear impatient.

In 1852, on his resignation of the appointment of visiting physician,
Conolly’s connection with Hanwell practically ceased, and a piece
of plate and his own portrait by Sir W. Gordon were presented to
him at a public meeting by Lord Shaftesbury. In his reply on this
occasion Dr. Conolly said: “Those who know me well will believe me
when I say there never was an occasion when the sense of merit was
less reflected from the breast of the recipient of a public honour,
than it is from me at this moment.” He further stated that when he
had first heard of the establishment of Hanwell Asylum, he was seized
with a restless desire to become one day its head.

Many objects of philanthropy had Dr. Conolly’s untiring advocacy,
both before and after his retirement from Hanwell. Public
middle-class lunatic asylums, the education of medical men in mental
diseases, the establishment of idiot asylums, especially that at
Earlswood, were among these. He was the first doctor applied to
by Mrs. Plumbe in regard to the foundation of Earlswood, and his
co-operation with Dr. Andrew Reed was of the most essential service
to the enterprise.

Dr. Langdon Down, formerly Medical Superintendent at Earlswood, wrote
in regard to Conolly: “His visits were the most refreshing incident
of my recollection in connection with the asylum. Entering on my
work (in 1858) as an untried man, and finding myself allied to an
institution which had become unpopular at the Lunacy Board, I was
mainly decided on holding a position which had so much to overwhelm
one by the influence of Dr. Conolly. That influence was magical. The
humility of his character was only equalled by the real love he
manifested for the mentally afflicted.

“At the visits of the Board of Management, he would steal away from
his colleagues, and was to be found holding loving intercourse
with the little members of my charge in a way that one has never
seen before or since. Moreover, he so encouraged every official
in his or her work, that the savour of his visit lasted till
he again returned.... For myself, I have often had to seek his
counsel, and never without being struck with his judgment and the
fascination of his influence, the high resolve he inspired in one,
and what willingness he exhibited to maintain, co-equally with the
responsibility, the power of the Medical Superintendent, and thus
to prevent a repetition of those evils which he had so bitterly to
lament in his own experience.”

The years after Conolly left Hanwell were busily occupied with a
large practice, especially in mental cases. In a few years his
unceasing labour told on him, and he suffered much from chronic
rheumatism and neuralgia. Finally he was compelled to retire from
practice, when he took up his residence at Lawn House, Hanwell,
whence he could see the asylum in which he had spent so many
anxious hours. He finally lost mental energy, and was unable to
complete several treatises and records of experience which he
was contemplating. He, however, left an enduring memorial of his
life-work in “The Treatment of the Insane without Mechanical
Restraints,” 1856, written in a most readable style. We must not
omit to mention his courses of lectures on Insanity at the College
of Physicians and at the Royal Institution, his papers on Infantile
Insanity, and finally “A Study of Hamlet,” in which he brings the
most skilfully marshalled arguments to prove that Hamlet’s was a
real and not a feigned madness. As to Hamlet’s treatment of Ophelia
in Act II., Scene 1, and more especially in the scene where Hamlet
and Laertes met over her grave, he remarked; “The picture of madness
here is too minutely true, its lights and shades are too close to
nature to have been painted as a mere illustration of feigning,
and of feigning without intelligible purpose.” Both Sir Theodore
and Lady Martin (Miss Helen Faucit) considered his exposition most
satisfactory, and that it settled the question finally.

Conolly was carried off, after years of weakness, by an attack of
paralysis with convulsions, which was fatal in a few hours, on March
5, 1867. Few have left behind them a brighter record as physician and
philanthropist.

       *       *       *       *       *

Improvement in the treatment of the insane and the knowledge of
mental diseases has progressed rapidly in late years, owing to the
efforts and studies of many workers, among whom Drs. Bucknill,
Tuke, Hood, Lockhart Robinson, and Forbes Winslow are conspicuous.
The record of their work would lead us into too wide a field.
But the life-work of one of the sons-in-law of Dr. Conolly, HENRY
MAUDSLEY, is of a character which for good or ill has exerted, and is
exerting, a powerful influence on younger minds. We come here into
a region of work influenced by the philosophy of Darwin and Herbert
Spencer, applied to the physiology and pathology of mind, and to the
relationship between body and mind. The time is not yet come for
an impartial estimate of the striking works which Dr. Maudsley has
brought forth in fertile succession, in addition to his extensive
labours as one of the editors of the _Journal of Mental Science_. But
it is certain that every one who would place himself in a position
to estimate the strength of the so-called “materialistic” school,
whether he be a metaphysician, a doctor, or a person of average
culture, must read Dr. Maudsley’s works. They are written fearlessly,
and for the most part with admirable lucidity, displaying a knowledge
of literature and philosophy not often met with, combined with great
practical experience in mental phenomena.

Henry Maudsley was born near Giggleswick, in Yorkshire, on February
5, 1835. After receiving his early education at Giggleswick School,
he proceeded to University College, London, and took the M.B. degree
at London University in 1856, with the distinction of University
Scholar in Medicine. He proceeded to the M.D. degree in 1857. During
the years 1859-1862 he was Resident Physician to the Manchester
Royal Lunatic Hospital. Returning later to London he became for a
time Professor of Medical Jurisprudence at his old college, and later
Consulting Physician to the West London Hospital.

In an article on “The Theory of Vitality,” which Dr. Maudsley
published in the _British and Foreign Medico-Chirurgical Review_ in
1863 (republished in “Body and Mind,” 1870), he showed remarkable
power for a young man of twenty-eight. His conclusion was that
the conscious mind of man blends in unity of development with the
unconscious life of nature. He looked for the harmonisation of the
idealism of Plato and the realism of Bacon as the expressions of the
same truths.

In 1867 Dr. Maudsley published an important work on the Physiology
and Pathology of Mind. It was intended to treat of mental phenomena
from a physiological rather than from a metaphysical point of view
and secondly, to bring the manifold instructive instances presented
by the unsound mind to bear upon the interpretation of the obscure
problems of mental science, and to do what he could to put an end to
the inauspicious divorce between the two branches of his subject.
He energetically exposed the shortcomings of psychologists and
metaphysicians, and naturally encountered severe criticism, and it
may be allowed that some of his expressions were those of youthful
enthusiasm rather than of matured wisdom. But the book had such
merits, that a second edition was called for in the next year, and
before long exhausted, after which the book was out of print for some
years.

At length Dr. Maudsley republished in a modified form the “Physiology
of Mind” in a separate volume of 550 pages (1876), putting it
forward as a disquisition, by the light of existing knowledge,
concerning the nervous structures and functions which are the
probable physical foundations of those natural phenomena, which
appear in consciousness, or feelings, and thoughts. In this work he
says (p. 47) “that the subjective method—the method of interrogating
self-consciousness—is not adequate to the construction of a true
mental science has now seemingly been sufficiently established. That
is not to say that it is worthless; for when not strained beyond its
capabilities, its results must, in the hands of competent men, be as
useful as they are indispensable.... That which a just reflection
teaches incontestably, the present state of physiology illustrates
practically. Though very imperfect as a science, physiology has made
sufficient progress to prove that no psychology can endure except it
be based upon its investigations.”

Meanwhile Dr. Maudsley had been called upon in 1870 to deliver the
Gulstonian Lectures at the College of Physicians, and these were
published in a small book under the title “Body and Mind: an Inquiry
into their Connection and Mutual Influence, specially in Reference
to Mental Disorders.” The first lecture expounded the physical
conditions of mental function in health; the second described some
forms of mental degeneracy which showed prominently the operation of
physical causes from generation to generation, and the relationship
of mental disorders to other diseases of the nervous system. The
third included a general survey of the pathology of the mind, and the
relations of morbid states of body to disordered mental function.

Meanwhile some important medico-legal cases had brought into
prominence Dr. Maudsley’s belief that there are many forms of
mental disease in which a patient ought not to be held criminally
responsible for his actions, although he might be fully cognisant of
their nature. This was definitely expressed as far back as 1864 in a
pamphlet entitled “Insanity and Crime,” a medico-legal commentary on
the case of George Victor Townley, by the editors of the _Journal of
Mental Science_. It was in 1872 more fully developed by Dr. Maudsley
in his “Responsibility in Mental Disease,” which has gone through
numerous editions.

In 1879 the “Pathology of Mind” appeared in a separate and enlarged
form, and contains a systematic exposition of the subject, introduced
by an account of sleep, dreaming, somnambulism, and allied states.
He then proceeds to deal with the causation of insanity, both social
and material, and then further expounds the symptoms of insanity,
treating it as one disease with varied manifestations, and then
delineating the clinical groups of mental disorders met with in
practice and which the physician has to deal with. One great merit
of the book is, that the clinical pictures it contains are drawn from
life. An extract from chapter iv., dealing with the influence of
conditions of life on the production of insanity, will show how at
every step Dr. Maudsley introduces considerations bearing on morality.

“The maxims of morality which were proclaimed by holy men of old as
lessons of religion indispensable to the well-being and stability of
families and nations, are not really wild dreams of inspired fancy,
nor the empty words which preachers make them; founded on a sincere
recognition of the laws of nature working in human events, they
were visions of eternal truths of human evolution. Assuredly the
‘everlasting arms’ are beneath the upright man who dealeth uprightly,
but they are the everlasting laws of nature which sustain him who,
doing that which is lawful and right, leads a life that is in
faithful harmony with the laws of nature’s progress; the destruction
which falls upon him who dealeth treacherously and doeth iniquity,
‘observing not the commandments of the Lord to obey them,’ are the
avenging consequences of broken natural laws. How long will it be
before men perceive and acknowledge the eternity of action, good
or ill, and feel the keen sense of responsibility, and the strong
sentiment of duty which so awful a reflection is fitted to engender?
How long before they realise vividly that under the reign of law on
earth sin or error is inexorably avenged, as virtue is indicated,
in its consequences, and take to heart the lesson that they are
determining in their generation what shall be predetermined in the
constitution of the generation after them?”

A later important work is “Body and Will,” 1883. “Its justification
from my standpoint,” says Dr. Maudsley, “is, that I have been engaged
all my life in dealing with mind in its concrete human embodiments,
and that in order to find out why individuals feel, think, and do
differently, and in what way best to deal with them so as to do one’s
duty to oneself and to them, I have had no choice but to leave the
barren heights of speculation for the plains on which men live and
move and have their being. It is not enough to think and talk about
abstract minds and their qualities when you have to do with concrete
minds that must be observed, and studied, and managed.”

This work deals with questions too vast to be summarily discussed;
but one aspect of Dr. Maudsley’s mind is well expounded in the
following extract:—

“In nature, as we see it, we seem to see a conflict of warring
opposites; gravitation opposed, or rather indeed complemented, by
repulsion; chemical affinities by chemical repulsions; magnetic
attraction by electric repulsion; evolution by dissolution;
conservation by revolution, quiet or catastrophic; love by hate;
self-love by love of kind; heaven by hell. Certain it is that hate
and destruction are just as necessary agents as love and production
in nature, which could no more be, or be conceived to be, without
the one than without the other; and to call the one good more than
the other, however necessary from the standpoint of human egoism,
is just as if one were to call gravitation good and repulsion bad,
as gravitation, had it self-consciousness, would no doubt do. In
order to have a theory of cosmogony that shall cover all the facts,
it has always been necessary to supplement a good principle by a
bad principle, a God of love and creation by a God of hate and
destruction. And it must always be so. We may, agreeably to the logic
of our wishes, comfort ourselves in our pilgrimage by entertaining
the hope and belief of the working out of good through evil and of
the permanence of good after the disappearance of evil, just as, if
it were useful and pleasing to us to cherish the illusion, we might
persuade ourselves that repulsion will one day be annihilated and
gravitation endure, or that evolution will continue and dissolution
cease to be; but if we look at the matter in the cold spirit of
strictly rational inquiry we shall always find abundant reason to
believe that the sum of the respective energies of good and evil
remains a constant quantity, the respective distribution only
varying, and that we might as well try to increase the height of the
mountain without increasing the depth of the valley, as to increase
the good in the world by purging it of its so-called evil.”

Dr. Maudsley became a Fellow of the College of Physicians in 1869,
has been President of the Medico-Psychological Association, and
received the LL.D. degree from Edinburgh University in 1884.


FOOTNOTES:

[17] “Treatment of the Insane without Mechanical Restraints,” 1856.

[18] For details of the exposure of 1813 and 1814, see “A History of
the York Asylum,” York, 1815.

[19] For a description of the state of Bethlem Hospital in 1815, see
Conolly’s work above cited, pp. 26-29. In making this record Conolly
says, “Nothing can more forcibly illustrate the hardening effect of
being habitual witnesses of cruelty, and the process which the heart
of man undergoes when allowed to exercise irresponsible power. Partly
from custom, and partly from indifference, and partly from fear, even
physicians not particularly chargeable with inhumanity used formerly
to see patients in every form of irritating restraint, and leave them
as they found them. _Such facts justify the extremest jealousy of
admitting the slightest occasional appliance of mechanical restraints
in any asylum. Once admitted, under whatever pretext, and every abuse
will follow in time._”

[20] Memoir of John Conolly, M.D., D.C.L., by Sir James Clark,
Bart., 1869; very ill-arranged.




CHAPTER XXV.

_EMINENT SPECIALISTS._

  _SIR ERASMUS WILSON AND SKIN DISEASES; MORELL MACKENZIE AND THROAT
  DISEASES; COBBOLD AND INTERNAL PARASITES._


Specialisation is decreed by the will of the public as much as by
that of the practitioner. This is true of many professions besides
those of medicine. Although the general discernment has always
recognised the ability of men with powers of the universal type,
these men are rare, and there is a strong tendency to believe that a
man cannot be master of the whole field of a science, but may more
probably be master of a portion of it. Again, with hawk eye the
people who want to be cured of disease mark and then swoop down upon
men who appear to them specially capable in one department of medical
practice, and no denunciation of specialism, no drawing back on the
part of the physician, will avail against this natural selection. The
man to whom crowds of patients of one kind flock naturally becomes
specially skilled in dealing with them: and it is impossible to stem
the tide by saying that such ought not to be the case.

Specialism has been carried to a surprising extent in America, when
Dr. Morell Mackenzie informs us, in his article on “Specialism in
Medicine,”[21] it would be almost impossible to find a city with
ten thousand inhabitants in which there are not three or four
specialists; whilst in a city of one hundred and thirty thousand
inhabitants, thirteen specialists were found exclusively engaged in
treating throat diseases.

The days of encyclopædic knowledge may be past, but the need of
a broad, general, scientific, and professional education for the
medical man, even a specialist, will never cease. If, as Dr.
Mackenzie says, the leviathans of omniscience loom dim and gigantic,
like the megatherium and mastodon of remote geological periods, and
if the type is as utterly extinct as he believes, it is all the
more incumbent on the guides of medical instruction to see that
their pupils pass through a broad course of study which shall fairly
represent the achievements of the past and the main features of the
knowledge of the present. ERASMUS WILSON was a man who undoubtedly
gained a good record in general professional knowledge, and knew well
the anatomy and physiology of his student days.

William James Erasmus Wilson, son of William Wilson, surgeon, a
native of Aberdeen, in early life a naval surgeon, who later settled
at Dartford and Greenhithe in Kent, was born on November 25, 1809,
in High Street, Marylebone, where his maternal grandfather, Erasmus
Bronsdorph, a Norwegian by birth, resided. He was educated at
Dartford Grammar School and at Swanscombe, but very soon commenced
practical medical work under his father in the parish infirmary.
At the early age of sixteen he was sent to London to enter John
Abernethy’s anatomical class, and there is no doubt that his
teacher’s individuality powerfully impressed him. But among his
friends were some who led his tastes also somewhat deeply into botany
and zoology, entomological facts then learnt being destined to bear
fruit in his Commentary on Diseases of the Skin.

Wilson was enabled to extend his studies to Paris in 1828 and
in 1830, where he attended Cuvier’s and Geoffroy St. Hilaire’s
lectures, and among others saw the practice of Dupuytren, Orfila, and
Lisfranc. He became noted for his neat dissections, insomuch that
he was nicknamed the “piocheur,” or “sap” in English slang. To his
excellence in dissection young Wilson joined an equal faculty for
drawing, derived from his mother.

In 1826 young Wilson had become a resident pupil with Mr. Langstaff,
father of a fellow-student, surgeon to the parish infirmary of
Cripplegate. Here in Langstaff’s dissecting-room, where many
pathological researches were carried on, Wilson made the acquaintance
of numerous men of mark who resorted thither, including Jones Quain
and William Lawrence. On the establishment of the Aldersgate School
of Medicine under Lawrence’s régime, Wilson joined it as student, and
in 1829-30 won both the surgical and the midwifery prizes. On the
day when he attained his majority, November 25, 1830, Wilson took the
Apothecaries’ Hall diploma.

Having become a member of the London College of Surgeons in 1831,
Wilson was asked by Dr. Jones Quain, then Professor of Anatomy and
Physiology at University College, London, to be his assistant, and
he soon after was appointed Demonstrator of Anatomy under Richard
Quain. Wilson was a capital teacher of anatomy, and his private
museum of dissections prepared by his own hands fully illustrated
his manipulative capacity. He superintended the execution of the
illustrations to the celebrated Quain’s Anatomy, and also those to
Liston’s Practical Surgery (1837).

When Dr. Jones Quain retired from University College Hospital in
1838, Wilson resigned his appointments also, and established a school
of anatomy under the title of Sydenham College, which however did not
prove ultimately successful. He then devoted himself to such private
practice as he could obtain in Charlotte Street, Fitzroy Square,
eking out his income by taking pupils, and by literary work. In 1838
he appeared as an author with “The Dissector’s Manual of Practical
and Surgical Anatomy,” subsequently producing the “Anatomist’s Vade
Mecum” (1840), of which many editions have been called for. In
the same year he became Lecturer on Anatomy and Physiology at the
Middlesex Hospital.

Meanwhile Wilson had made the acquaintance of a man who was destined
to turn his thoughts in the direction which became permanent. His
father, after retiring from the navy, had taken a mansion at Deham,
Bucks, and set up a private lunatic asylum; and in connection with
this establishment Wilson met Mr. Thomas Wakley, M.P., the founder of
the _Lancet_, and coroner for Middlesex. Mr. Wakley appointed Wilson
sub-editor of the _Lancet_ in 1840, a post which he held for several
years, continuing to write for that journal after resigning the more
onerous post when his private practice increased. About this time he
became Consulting Surgeon to the Marylebone Infirmary, and gained a
very extensive experience of every department of hospital surgery. In
fact, it appeared at first that Wilson would probably make his mark
as a pure surgeon.

No more certain path, however, opening in this direction, Mr. Wakley
considerably influenced Wilson towards choosing a special line of
practice as a means of success. There was much open opposition
at that time among medical men to the idea of specialisation,
and Mr. Wakley succeeded in overcoming Wilson’s fear of sinking
under the dreaded name of quack. The choice of a specialty was not
difficult, as skin diseases or dermatology then constituted an almost
uncultivated field. “I have never regretted my choice,” he remarked
on one occasion;[22] “there is only one more beautiful thing in the
world than a fine healthy skin, and that is a rare skin disease.”

In 1842 Wilson brought out his extended systematic work on Diseases
of the Skin, and subsequently produced twelve fasciculi of folio
“Portraits of Diseases of the Skin.” In connection with these we may
mention that he took a large share in the well-known five volumes
of Anatomical Plates, issued jointly by Dr. Quain and himself. In
1843 he was elected a Fellow of the College of Surgeons, and in 1844
a Fellow of the Royal Society, having contributed to the latter
a memoir on a newly-discovered parasite on the human skin, the
_Entozoon folliculorum_. He made himself familiar with varieties
of skin diseases by extensive vacation rambles—in Switzerland and
the Valais studying goitre, in Italy searching out ringworm cases
among the peasantry, in the East making leprosy a special object of
inquiry. He wrote the article “Skin” in Cooper’s Surgical Dictionary,
a Report on Leprosy, and many articles on various subjects connected
with the specialty.

Thus Wilson became a specialist of great merit as well as profitable
practice, and, says the _Lancet_ (August 16, 1884), “knew more about
skin diseases than any man of his time. He cured when others had
failed to cure; and his works on dermatology, though they met with
pretty searching criticism at the time of their appearance, have
nearly all maintained their position as text-books. The horrible
cases of scrofula, anæmia, and blood-poisoning which he witnessed
among the poor of London—they are happily rarer now than they were
half a century ago—enlisted his warm sympathies. But he had to deal
with rich patients as well as poor, and over these the masterful
stamp of his mind enabled him to exercise despotism in matters of
diet. Wilson was not only a consummate dietician, but he knew how to
make his patients submit to have their bodies placed under martial
law.” He in fact largely viewed skin diseases as expressions of
internal derangement and constitutional defects. He was continually
on the look out for deficiency of nutrition in children and remedying
it.

Wilson was much pleased to be the means of bringing forward a little
work on “Infant Life: its Nurture and Care,” written anonymously by
a lady, and first published in his “Journal of Cutaneous Medicine.”
In the preface which he wrote to it he expresses his strong beliefs
that hygiene is the first necessity of a scholastic institution,
that with proper nurture almost all the diseases of infants would be
extinguished, that illness following vaccination properly performed
can only occur owing to neglect of proper nurture and care, and that
“healthy children never suffer, never die from vaccination.”

An incident which brought Erasmus Wilson prominently before the
public was the inquest held at Hounslow on a soldier who had died
after a regimental flogging. Mr. Wakley held the inquest, which
lasted eleven days. It was in a great measure owing to Mr. Wilson’s
decided evidence that a verdict was returned declaring that the
flogging had been the cause of death. The public feeling was aroused,
a Parliamentary inquiry was subsequently held, and the punishment of
flogging was at last removed from the regimental code.

Several works of considerable merit made Wilson’s name very widely
known. One of the most popular of these was entitled “Healthy Skin,”
first published in 1845. It strongly advocated that constant use of
the bath which has become far more prevalent than when it was first
issued. A translation of Hufeland’s “Art of Prolonging Life,” which
he edited, appeared in 1853. In “The Eastern or Turkish Bath,” in
1861, Wilson gave a powerful impetus to the establishment and spread
of the Turkish bath in England, and laid down principles and plans
of procedure calculated to make this bath safe for persons of very
varied constitutions.

In 1869 Erasmus Wilson founded at his own cost a museum and
professorship of dermatology at the College of Surgeons, with an
endowment of £5000, and was appointed the first professor. In this
capacity he lectured for nearly ten years. Several successive series
of lectures were published, as well as a catalogue of the museum.
He was also the founder of the Chair of Pathology in Aberdeen
University. He also endowed a pathological curatorship at the College
of Surgeons. He was elected on the Council of the College in 1870,
and was President in 1881. A special grant of an honorary gold medal
was made to him by the College in 1884, just before his death.

His early Eastern travels had particularly interested Wilson in
Egyptology, and he became by wide reading and study very competent
in Egyptian lore, as is evidenced by his “Egypt of the Past,”
published in 1881. His munificence in connection with the bringing
of the obelisk known as “Cleopatra’s Needle” to London in 1877-8 is
a familiar story. Many abortive proposals had been made to secure
its being brought to England, but Government had always failed to
make any arrangement. General Sir James Alexander was the means of
starting the idea in Erasmus Wilson’s mind, by speaking to him of
a project for raising sufficient money by a general subscription.
Wilson, who was greatly interested, thought the sum needed, £10,000,
would not be forthcoming, and undertook to pay the entire sum
himself, Mr. John Dixon, C.E., having undertaken its successful
transport. Thus Britons will ever owe to him the possession of this
choice treasure of Egyptian antiquity. The book entitled “Cleopatra’s
Needle: with Brief Notes on Egypt and Egyptian Obelisks,” which
Wilson brought out in 1877, went through several editions.

But these were only a few of the public objects to which Erasmus
Wilson devoted his wealth, which had been vastly increased by
singularly skilful investments in gas and railway companies’ shares.
He restored Swanscombe Church, near his birthplace, in 1873. He
founded, at a cost of £2500, a scholarship at the Royal College of
Music, besides contributing considerably to its general funds. He was
a large subscriber to the Royal Medical Benevolent College at Epsom,
and built at his own cost a house for the head-master; further, he
built at a cost of £30,000 a new wing and chapel for the Sea-Bathing
Infirmary at Margate, in which skin diseases are largely treated. He
was a strong Freemason, and contributed liberally to various Masonic
charities. In recognition of his many public benefactions he was
knighted in 1881.

“From his earliest life,” says the _British Medical Journal_ (August
16, 1884), “he was characterised particularly by his kindliness and
gentleness of manner, which made him many friends; indeed, to know
him was to love him. His generosity to poor patients who came to
consult him was very great, not only prescribing for them gratis,
but supplying the means for carrying out the treatment, and that
not only after he became wealthy, but even at a time when he could
ill afford to be generous. The amount of good he did privately will
probably never be known, as he was one of whom it may truly be said,
that he never let his left hand know what his right hand did—so
unostentatious was he in regard to his charity.”

Sir Erasmus Wilson had been in ill-health for two years before his
death, and for a year was quite blind, yet never lost cheerfulness.
On July 23, 1884, he was at the consecration of St. Saviour’s Church
at Westgate on Sea, of which he had laid the foundation-stone a year
before. Within three days he became seriously ill, and died on August
7th. He had married in 1841 a Miss Doherty, who survived him. He left
no family, and the bulk of his property, something like £180,000,
reverts on Lady Wilson’s death to the College of Surgeons, without
any restriction as to the disposal of the fund. Other legacies of
£5000 each he bequeathed to the Sea-Bathing Infirmary at Margate, the
Medical Benevolent College, and the Society for the Relief of the
Widows and Orphans of Medical Men. Such bequests alone would place a
man among great public benefactors. Wilson had not waited till death
came before he became beneficent, and if his gifts are used in the
spirit in which he gave them, he will rank with John Hunter as to the
material if not the intellectual legacy he has bequeathed to mankind.

       *       *       *       *       *

Descended from an old Scotch family (the Mackenzies of Scutwell),
Dr. MORELL MACKENZIE is the son of the late Mr. Stephen Mackenzie,
surgeon, of Leytonstone, by his wife Margaret, daughter of Mr. Adam
Harvey of Lewes. Morell Mackenzie was born at Leytonstone, on the
borders of Epping Forest, on the 7th July 1837. His father was a man
of exceptional intellectual power, whose studies took the direction
of metaphysics and mental diseases; hence he acquired great skill in
treating nervous affections which border on insanity. His ability
was testified to by Mr. Brudenell Carter in his valuable essay on
Hysteria (see p. 268). Mrs. Mackenzie was a clever woman of a highly
practical tendency. The untimely death of Stephen Mackenzie in 1851,
when he was thrown out of his gig and killed on the spot, left his
widow with nine children very slenderly provided for.

Morell Mackenzie was educated by Dr. Greig of Walthamstow, many of
whose pupils entered the service of the East India Company. Mackenzie
always took a great interest in natural history, in which he was
largely encouraged by his mother, and from an early period greatly
desired to enter the medical profession. But a medical education
being then beyond the means of the family so suddenly bereaved, he
was placed at the age of sixteen in the office of the Union Assurance
Company in Cornhill. Here he got on very well, but never abandoned
the hope of becoming a doctor. Fortunately, by the kind aid of a
relative, he was enabled to gratify this desire, and he accordingly
resigned his clerkship, and became a student at the London Hospital.

On commencing his medical studies Mackenzie determined to take his
degree at the University of London, combining with his hospital work
the preparation for matriculation. Having become a member of the
College of Surgeons in 1858, he subsequently took the M.B. degree
with high honours in three subjects. At the London Hospital he
obtained the senior gold medal for surgery, and the gold medal for
zeal, talent, and humanity to the patients, awarded by the governors.
On leaving the hospital he went to Paris, where he studied for a
year under Trousseau, Nélaton, Ricord, and others. He spent another
year in Vienna, where he studied pathology under Rokitansky, chest
diseases under Skoda, skin affections under Hebra, and diseases of
the eye under Arlt and Jäger. During his stay at Vienna Mackenzie
made an expedition to Pesth in order to become acquainted with
the laryngoscope, an instrument invented by Manuel Garcia, which
Czermak was then beginning to use. A friendship sprang up between
these two men which only terminated with Czermak’s lamented death.
Czermak was very desirous that Mackenzie should translate some of
his papers and publish them in the English medical journals, but he
had determined to study for a few months in Italy, and before he
returned home Czermak had himself come over to London and introduced
the laryngoscope into England. On arriving in London Mackenzie was
at once appointed Resident Medical Officer at the London Hospital,
and shortly afterwards Registrar to that institution. He now began to
make daily studies with the laryngoscope, and soon published cases in
the medical journals which had been treated by its aid. In 1862 he
completed the M.D. degree at London University.

In 1863 the Jacksonian prize for an essay on the Diseases of the
Larynx was awarded to Mackenzie by the Royal College of Surgeons,
and on the urgent advice of many of his medical friends, especially
that of the late Dr. Herbert Davies, he determined to make throat
diseases a specialty, and having established himself in practice in
the West End, he was largely instrumental in founding the Throat
Hospital in King Street, Golden Square, in the same year. In 1866 Dr.
Mackenzie was appointed Assistant-Physician to the London Hospital,
and his colleagues subsequently offered to recommend to the committee
of that institution that a department for throat diseases should be
established under his supervision. This however he declined, on the
ground that he wished to treat diseases of every kind whilst attached
to the London Hospital. He, however, gave a course of lectures on
Throat Diseases at the London Hospital Medical College, whilst he
also lectured on Physiology for three years. Dr. Mackenzie was
afterwards obliged, owing to his increasing practice, to resign his
connection with the London Hospital.

Dr. Mackenzie has for many years occupied a prominent position
not only as a specialist but as a champion of specialism, and has
exhibited considerable persistence in his advocacy of any cause with
which the interests of specialism were connected. Some years ago,
when most of the special hospitals were excluded from participation
in the London Hospital Sunday Fund, Dr. Morell Mackenzie led the
attack upon the position taken up by the committee, with the result
that the treasurer of the Fund resigned, and a modification of
procedure took place. Dr. Mackenzie, among the other honorary
memberships of foreign societies which have been conferred upon him,
is one of the two honorary Fellows of the American Laryngological
Association, Signor Garcia being the other. He has invented a number
of instruments or modifications of instruments for the treatment
of throat diseases, and has written copiously on the subject. His
principal works are entitled “On the Use of the Laryngoscope in
Diseases of the Throat,” “Essays on Throat Diseases,” “Diphtheria,”
“Hay Fever,” and “Diseases of the Throat and Nose.” He has also
written the article on Diseases of the Larynx in Reynolds’s “System
of Medicine.”

Dr. Morell Mackenzie claims that his experience as to diseases of the
throat amply justifies and necessitates specialism. “The scientific
literature relating to these,” he says (_Fortnightly Review_, June
1885), “dates from little more than twenty-five years back, and
already it has grown to a bulk that would surfeit the voracity of the
most persevering bookworm, and it goes on increasing and multiplying
in a manner that makes one long for a Malthus to preach some degree
of moderation to its producers. Every week, every day brings one
books, pamphlets, articles, lectures, reprints about all sorts of
uncomfortable things in _itis_ and _osis_, as seen in the throats of
Englishmen, Frenchmen, Germans, Italians, Danes, Russians, Americans,
and all the other offspring of Babel. A certain proportion of these,
no doubt, are of great value, but not a few might be consigned to
the wastepaper basket without serious loss to science; all must be
read, however, lest some grains of wheat should be thrown away with
the chaff. Several periodicals dealing exclusively with diseases of
the throat appear with praiseworthy regularity; and there are also
societies, associations, &c., founded for the same purpose, each of
which, of course, issues its yearly volume of Transactions.... This
may give some faint idea of the herculean labour which the specialist
who wishes to keep abreast of the progress of knowledge in his own
subject from the literary point of view alone has to undergo; and
it must be remembered that in medicine reading is after all only
subsidiary to the practical work by which skill is perfected and
experience gathered and extended.”

       *       *       *       *       *

The subject of animal parasites upon and in the human body, while
certainly not one of the most attractive on a superficial view, has
yet been found to yield scientific material of the highest interest,
and has required great energy and care to produce satisfactory
results. Among British workers in this field none is more widely
known than Dr. THOMAS SPENCER COBBOLD, F.R.S.

Dr. Cobbold is the third son of the late Rev. Richard Cobbold,
rector of Wortham, Suffolk, the author of the striking “History of
Margaret Catchpole,” and his grandmother, Mrs. Cobbold, was a zealous
geological collector in the early days of geology, having a fossil
species of mollusc (_Nucula Cobboldiæ_) named in her honour. The
subject of this notice was born at Ipswich in 1828, and educated for
some years by the Rev. H. Burrows, at Yarmouth, and afterwards at the
Charterhouse.

Young Cobbold entered upon the study of medicine at the Norfolk
and Norwich Hospital in 1844, as pupil of Mr. Crosse, F.R.S. Later
he proceeded to Edinburgh, and became class-assistant to Professor
Hughes Bennett, and prosector to Professor Goodsir, then at the
height of his career. Such men, and especially Goodsir, exercised a
great awakening influence on young Cobbold, and deepened his strong
tendencies towards anatomical research. In 1851 Dr. Cobbold graduated
on the same day as Dr. Burdon-Sanderson, now Waynflete Professor
of Physiology at Oxford, and the late Dr. Charles Murchison, all
three being gold-medallists. After studying for some time in Paris,
Dr. Cobbold on his return to Edinburgh was appointed curator of
the Anatomical Museum, and became active in dissecting specimens
of animals received at the museum. Among others his memoir on
the giraffe and other ruminants formed the basis of his article
Ruminantia, contributed to Todd and Bowman’s Cyclopædia of Anatomy
and Physiology. When the lamented Edward Forbes was elected to the
chair of Natural History, Dr. Cobbold’s attention was powerfully
attached to geology, and for some years he made excursions with
his class, and collected large numbers of fossils. More distant
excursions to Arran, the Yorkshire and Devonshire coasts, the Isle of
Wight, &c., supplied Dr. Cobbold with specimens of great service in
illustrating the Swiney Lectures, which he afterwards delivered for
five years with marked success at the British Museum and at the Royal
School of Mines (1868-72). So popular did these lectures become that
towards the close of the last course many of the visitors could not
find seats.

After the death of Edward Forbes, Dr. Cobbold resigned his
appointments in Edinburgh, and became Lecturer on Botany at St.
Mary’s Hospital. Two years later he transferred his services to the
Middlesex Hospital, lecturing there for thirteen years on Zoology
and Comparative Anatomy. During his connection with the Middlesex
Hospital he took up the branch of zoology and medicine with which his
name will be most distinctively associated. During three successive
years he examined the bodies of animals dying at the Zoological
Gardens, especially with a view to discovering the presence of
parasitic worms in them. Many papers were contributed by him to the
Linnean and Zoological Transactions and Proceedings, among which we
may call attention to “Remarks on all the Human Entozoa” (Zool. Soc.
Proc., 1862).

In 1864 Dr. Cobbold was elected F.R.S., and in the same year
published his “Introductory Treatise on the Entozoa,” which
established his reputation, the _Lancet_ declaring that it formed a
noble contribution to medical science and a credit to our national
literature. Up to the year 1865 Dr. Cobbold persevered in the
pursuit of pure science, refusing all inducements to practice; but
finding that after his twenty years of zealous labour, no suitable
scientific post opened for him, he at length commenced practice in
Wimpole Street, removing later to Harley Street. Here his great
knowledge of the habits and treatment of internal worm parasites
became available for professional purposes, and his services were
largely sought. But scientific pursuits and public lecturing still
claimed his attention, and among the achievements of his later years
are his book on Tapeworms, which has gone through several editions;
his lectures on practical helminthology, entitled “Worms;” a manual
of the “Parasites of the Domesticated Animals,” a larger treatise
on Parasites, a smaller supplementary work on Human Parasites. In
1873 Dr. Cobbold received the appointment of Professor of Botany at
the Royal Veterinary College, and soon afterwards a special chair
of helminthology was established for him at the College, for giving
instruction on the parasites and parasitic diseases of domesticated
animals to veterinary students. In connection with this work. Dr.
Cobbold went still more deeply into the parasitic diseases of
domestic animals, such as those which caused grouse disease, ostrich
and pigeon epidemics, gapes in chickens, &c. He delivered a course
of lectures on the “Parasites of Animals employed as Food” at the
Society of Arts. He has been the first to describe many new species
of internal worms from elephants, horses, cattle, sheep, and dogs.
One of the most elaborate of his special memoirs is that in which he
has described the parasites of elephants, in the Linnean Society’s
Transactions. With these extensive researches in comparative anatomy,
Dr. Cobbold has not neglected human parasites of late years, and
various papers and lectures of his have commanded much attention and
elucidated important points. He contributed fifty short articles on
these subjects to Quain’s “Dictionary of Medicine.” As a lecturer
Dr. Cobbold’s style is highly popular and pleasing. He possesses to
a great degree the power of putting himself on good terms with his
audience and keeping them interested. His position in regard to the
investigations with which his life has been chiefly occupied has been
quite unique.

An extract from his work on Entozoa is an interesting example of a
very successful mode of treating this subject. “The happiest, and
perhaps after all the most truly philosophic, way of studying the
entozoa, is to regard them as a peculiar fauna, destined to occupy an
equally peculiar territory. That territory is the widespread domain
of the interior of the bodies of man and animals. Each animal or
“host” may be regarded as a continent, and each part or viscus of
his body may be noted as a district. Each district has its special
attractions for particular parasitic forms; yet, at the same time,
neither the district nor the continent are suitable localities as
a permanent resting-place for the invader. None of the internal
parasites ‘continue in one stay;’ all have a tendency to roam;
migration is the very soul of their prosperity; change of residence
the _sine quâ non_ of their existence, whilst a blockade in the
interior, prolonged beyond the proper period, terminates only in
cretification and death.”


FOOTNOTES:

[21] _Fortnightly Review_, June 1885, p. 775.

[22] _World_, September 18, 1878.




CHAPTER XXVI.

_EMINENT SPECIALISTS—continued._

_SIR W. BOWMAN, BRUDENELL CARTER, AND EYE DISEASES; TOYNBEE, HINTON,
AND EAR DISEASES._


The eye, the organ of light, was, till recent times, practically
a dark chamber. Only its grosser movements and the effects of its
lenses upon the rays of light were understood. Its minute structure,
its relationship to the brain, and the real nature of the morbid
changes occurring in it, were hidden. To-day its microscopic elements
are unravelled, and very much is known of their connexion with the
great nerve-centres behind them. Experiment and calculation have
gone far to settle the precise mode in which light gives rise to
sight, and affects our perception and judgment of external objects,
and the condition of the eye during life and health or disease has
been brought into view by the ophthalmoscope. The names of Helmholtz
and of Donders are inseparably connected with modern advances in the
physiology of the eye, while no English name is more conspicuous in
regard to the surgery of the eye than that with which we commence
this chapter.

WILLIAM BOWMAN, the third son of Mr. J. Eddowes Bowman, banker,
of Nantwich, and afterwards of Welshpool and Wrexham, was born at
Nantwich on July 20, 1816. He was early surrounded by scientific
associations, for his father was a botanist and geologist of wide
cultivation, having formed a very complete herbarium of British
plants, and having furnished to Sir Roderick Murchison valuable
original matter for his “Silurian System.”

Mr. Bowman placed his son at Hazelwood School, Birmingham, which
Sir Rowland Hill’s father was conducting on the principle of
the abolition of corporal punishment. The boys largely governed
themselves, printing a magazine of their own. They were taught
natural science too, a very unusual thing in those days. In such a
congenial atmosphere young Bowman flourished, and in time became head
boy.

An accident to one of his hands, about the close of his school
course, seems to have led to Mr. Bowman’s choice of surgery as a
profession. For some months he saw country practice with Mr. T. T.
Griffith, of Wrexham, seeing a good deal of cholera, which was then
prevailing, and spending his leisure in copying anatomical drawings
of the human bones and muscles. He then became, through the interest
of Mr. Joseph Hodgson, F.R.S., afterwards President of the College of
Surgeons, who had attended to his injured hand, a resident pupil at
the General Hospital, Birmingham, where he continued for five years.

These early years were fruitful in microscopical observations of both
healthy and diseased tissues, and even in experimental physiology,
for Mr. Bowman was one of those whose advancement in science has been
considerably due to experiments upon animals. In 1837, after a brief
visit to the Dublin medical schools, he became a student at King’s
College, London, where Robert Bentley Todd had been lately appointed
Professor of Physiology. Mr. Bowman’s skill and extensive knowledge
were soon made use of by Todd, and he was successively appointed
prosector and demonstrator of anatomy and curator of the anatomical
museum.

In 1838 Mr. Bowman visited the hospitals and museums of Holland,
Germany, and Vienna, and made a considerable stay in Paris in 1841.
Meanwhile his original studies were bearing fruit in important
papers contributed to the Royal Society, “On the Minute Structure
and Movements of Voluntary Muscle” (1840), “On the Contraction of
Voluntary Muscle in the Living Body” (1841), and, “On the Structure
and Use of the Malpighian Bodies of the Kidney” (1842). The latter
marked a conspicuous advance in the physiology of the kidney, and Mr.
Bowman was distinguished by receiving a royal medal for it, having
been elected F.R.S. in the previous year. Professor Michael Foster,
in his address on Physiology to the International Medical Congress of
1881, referred to these memoirs on muscle and the kidney as “classic
works, known and read of all instructed physiologists.”

In 1840 Mr. Bowman, at the early age of twenty-four, was appointed
Assistant-Surgeon to King’s College Hospital. His scientific writing
became much in demand. He wrote on Surgery in the “Encyclopædia
Metropolitana,” on Muscle, Motion, and Mucous Membrane in Todd’s
“Cyclopædia of Anatomy and Physiology,” and took a large share with
Dr. Todd in writing and illustrating the “Physiological Anatomy
and Physiology of Man,” which was brought out in parts. The desire
to render this book as far as possible accurate and original by
repeating most of the observations of others and making new ones
where necessary, led to successive delays in the appearance of the
parts. Finally the closing part was written by Dr. Lionel Beale, and
published in 1856.

Having become a Fellow of the College of Surgeons in 1844, Mr. Bowman
in 1846 joined the staff of the Royal London Ophthalmic Hospital,
Moorfields, as assistant-surgeon, having already made extensive
researches into the minute structure of all the organs of special
sense. His advent to the Moorfields Hospital was marked by the
delivery, in 1847, of a series of lectures on the “Parts Concerned in
Operations on the Eye,” which were afterwards separately published.
It was evident that ophthalmic surgery had gained a distinguished
recruit. Mr. Bowman had, independently of Brücke, discovered the
ciliary muscle, and his work brought forward numerous other facts
of structure for the first time. His paper “On the Structure of the
Vitreous Body,” contributed to the _Dublin Quarterly Journal of
Medical Science_, also attracted good attention. His suggestions on
operations for artificial pupil in the _Medical Times and Gazette_
also showed conspicuous capacity for ophthalmic surgery.

Although much urged to devote himself exclusively to this branch
of practice, Mr. Bowman preferred to continue in general surgical
practice for many years, attaining the surgeoncy to King’s College
Hospital in 1856, two years after he had reached the full surgeoncy
at Moorfields. In 1848 he had been conjoined with Dr. Todd in the
professorship of physiology and general and morbid anatomy in King’s
College, retaining the professorship, after Dr. Todd’s retirement, in
conjunction with Dr. Beale. But by 1855 Mr. Bowman found himself so
fully occupied that he finally resigned the professorship. He held
the surgeoncy to King’s College Hospital till 1862.

From this period Mr. Bowman has been the acknowledged leader
of ophthalmic practice. He was one of the first to employ the
ophthalmoscope. His numerous papers in the Ophthalmic Hospital
Reports and in the Medico-Chirurgical Transactions have given
particulars of many improvements in operations on the eye, which
he has adopted, introduced, or improved. Lachrymal obstructions,
glaucoma, conical cornea, and cataract are among the subjects he
has specially dealt with; and he has by his clinical teaching and
operative example contributed not a little to the building up of
modern ophthalmic surgery. The well-earned honour of a baronetcy was
conferred upon him in 1884.

The breadth of Sir William Bowman’s sympathies is shown on the one
hand by the active part he took in the establishment in 1848 of
the St. John’s House Sisterhood for training nurses for hospitals,
families, and the poor, having joined its council from the beginning,
and having materially assisted Miss Florence Nightingale in her
various philanthropic nursing enterprises; and, on the other hand,
by his consistent advocacy of physiological experiment. He considers
that every step forwards in our knowledge of the healthy body must
lead to a better understanding of disease and an improvement of
our power of counteracting it, whether in the way of prevention,
alleviation, or cure.

In his address to the British Medical Association at Chester in
1866,[23] this eminent authority took occasion to protest forcibly
against the imputation of cruelty to animals sometimes made against
medical men in respect of physiological experiments. He insisted
both on the excessive difficulty of these original inquiries and
the high motives which actuate physiologists and the higher class
of scientific inquirers. “There should be no doubt,” said he, “as
to the free allowance of dissections of living creatures for the
advancement, and also for the communication, of a knowledge so
indispensable for our race, and for every generation of it.” He
practically charged the opponents of vivisection with stopping the
gates of knowledge, neither going in themselves nor suffering those
that were entering to go in.

The lofty view which Sir William Bowman takes of the surgeon’s
function may be gathered from an extract from the above-mentioned
address. “I see no reason to doubt that future ages will still accept
the pious saying of one of old, that surgery is the _Hands of God_;
the Human Hands, apt images and reflex of man’s whole being, from his
morning hour of puling helplessness, when the

     “... tender palm is prest
  Against the circle of the breast;”

through all his working day of time, until they shall be upraised
once more at last in joy and adoration, to hail a brighter and an
eternal dawning; the Human Hands, permitted now, through insight into
God’s laws, to be His instruments of succour to that earthly life and
organisation which His power, wisdom, and love have first brought
into being, still alone both sustain and cause to perish when their
part is played; to that material organisation which dies every hour
it lives, which indeed dies by living, and lives by dying, and which
wondrously transmits ever its own prerogatives and dark secrets to a
succeeding life, destined apparently to remain a marvel and a mystery
impenetrable to all generations.”

       *       *       *       *       *

The career of Mr. R. BRUDENELL CARTER is of special interest, owing
to the fact that he was a general practitioner in the country till
the age of forty, and came to London in 1868 without friends or
connection, intending to establish himself as a specialist in eye
diseases, and in a few years attained to eminence. But Mr. Carter’s
life had been previously marked by energy and success of no common
order; and his literary tastes and accomplishments ranked in the
forefront of the causes of his success.

A reference to Mr. Carter’s ancestry will show that good hereditary
influences met and combined in him. His father was a major in the
royal marines; his grandfather, rector of Little Wittenham in
Berkshire, was a younger brother of Elizabeth Carter, the well-known
poetess and translator of Epictetus, whose portrait by Lawrence is
in the National Portrait Gallery. The rector was entirely educated
by his learned sister till he went to Cambridge. The rector’s wife
was a granddaughter of John Wallis, the mathematician and astronomer,
one of the founders of the Royal Society. The Carters belonged to the
younger branch of a family which had held the manor of St. Columb
Major in Cornwall from the time of Henry VII.

Mr. Carter was born, at Little Wittenham on October 2, 1828. After
being at private schools he commenced his professional education by
apprenticeship to a general practitioner, and afterwards entered
at the London Hospital. After becoming a member of the College of
Surgeons in 1851 he practised for a short time at Leytonstone and at
Putney.

At this period Mr. Carter published his first work “On the Pathology
and Treatment of Hysteria” (1853). This was avowedly based to a
considerable extent upon the opinions and practice of Mr. Stephen
Mackenzie, then recently deceased, who was extensively known by his
successful treatment of the most inveterate hysterical disorders.
This work in itself sufficiently indicated the presence of a writer
possessing both clearness of view and moderation of statement.

This was followed by a much more extensive treatise “On the Influence
of Education and Training in Preventing Diseases of the Nervous
System” (1855). Mr. Carter was led to write it by observing the
frequent connection between faulty education and nervous or mental
disorders. It is divided into three parts, dealing respectively
with the Nervous System, Physical Education, and Moral Education.
The latter was that for the sake of which the book was written;
it displays a thoughtful moderation and breadth of view, without,
however, forecasting the author’s future eminence.

Immediately upon the completion of this book Mr. Carter started
for the Crimea, where he served with the army as staff-surgeon.
Returning home when peace was concluded, he settled in
Nottinghamshire, and soon moving into the town of Nottingham, took an
active part in the establishment of an eye hospital there. In 1862
he removed to Stroud in Gloucestershire, and founded an eye hospital
in Gloucester. In 1864 Mr. Carter became Fellow of the College of
Surgeons by examination.

In 1868 Mr. Carter took the important step of removing to London,
resolving to rely upon medical and other literary work mainly until
practice should come. Thus Mr. Carter has been the writer of very
voluminous contributions to journalism, and has shown great ease and
lucidity of style. In 1869 he was appointed Surgeon to the Royal
South London Ophthalmic Hospital, and in 1870 Ophthalmic Surgeon to
St. George’s Hospital. He has persevered in commenting severely upon
errors of modern education, and has especially dealt with evils done
in various ways to the eyes in modern life. One pamphlet of his, “On
the Artificial Production of Stupidity in Schools,” has been often
reprinted. In an address at the opening of the Medical Session at St.
George’s in 1873 Mr. Carter thus spoke of cramming: “The show pupils,
who furnish marvellous answers to a multiplicity of questions, on
a multiplicity of subjects, in response to the demands of various
preliminary or matriculation examinations, remind me of nothing so
much as of the wooden cannon which artillerymen call ‘Quakers,’ which
require for their production in unlimited numbers, besides the
blocks of wood, nothing but a turning-lathe and a paint-brush; and
which are mounted, to deceive the enemy, in embrasures that would
otherwise be vacant.... But our ‘competition wallahs,’ instead of
being used to deceive an enemy, have been used chiefly to deceive
ourselves.”

In 1875 Mr. Carter published an extended and important “Practical
Treatise on Diseases of the Eye.” In this he distinctly states that
in its normal condition the eye has faults which would condemn a
telescope or microscope to be thrown aside as useless, but which in
the living organ are neutralised by the conditions under which it
is exerted. He recommends any one who would operate upon the eye to
take a great deal of preliminary trouble, and to train his hands to
especial delicacy of action, so that he shall be indifferent which he
uses. “It has more than once been my lot,” he says, “to see attempts
to operate upon the human eye made by a surgeon who did not even
know how to hold the instruments he was about to misuse; and I can
conceive few things more painful than such a spectacle.” “In all
ages and countries the bad workman has complained of his tools, and
the good workman has produced the most varied results by the most
simple means. A man who is very awkward, and whose awkwardness is
perpetually bringing him to grief, hits upon a contrivance by which
he hopes that this natural result may in some degree be obviated. He
calls his contrivance an invention; and, like those persons of whom
it is said that their glory is in their shame, he is often somewhat
proud of it. Many surgeons of great and deserved repute have invented
each a single instrument, such as Beer’s knife or Tyrrell’s hook; and
some have invented more than one, chiefly because they have struck
out some new procedure for which new appliances were indispensable.
But as a rule the invention of many instruments by a surgeon may be
accepted as a sufficient proof of his clumsiness; and when, without
valid reason, any single operator has his peculiar scissors, and his
peculiar hook, and his peculiar forceps, and his peculiar scoop, all
called after his name, it is more than probable that the gift of
fingers has not been bestowed upon him.”

Mr. Carter in 1877 gave a course of lectures “on Defects of Vision
which are Remediable by Optical Appliances,” as Hunterian Professor
of Pathology and Surgery at the College of Surgeons. These were
published in the same year. He has since issued a more popular work,
“Eyesight—Good and Bad: a Treatise on the Exercise and Preservation
of Vision,” 1880. The following extract has to do with a very
injurious form of prejudice due to ignorance.

“The persons who suffer most from popular prejudice and ignorance
on the subject of spectacles are men of the superior artisan class,
who are engaged on work which requires good eyesight, and who, at
the age of fifty or sixty, find their power of accomplishing such
work is diminishing. It is a rule in many workshops that spectacles
are altogether prohibited, the masters ignorantly supposing them
to be evidences of bad sight; whereas the truth is that they are
not evidences of bad sight at all, but only of the occurrence of a
natural and inevitable change, the effects of which they entirely
obviate, leaving the sight as good for all purposes as it ever was.”
His general interest in education and its effects is abundantly
manifested as in the description of the late Mr. C. Paget’s half-time
experiment at Ruddington near Nottingham, where garden work was
substituted for about half the ordinary school hours of a portion of
the scholars. The children so treated were found after a short period
altogether to outstrip in their schoolwork those who devoted, or were
supposed to devote, twice as much time to it.

Mr. Carter has translated two valuable works bearing on his
specialty: viz., Zander on the Ophthalmoscope, and Scheffler on
Ocular Defects. He has contributed to “Our Homes, and How to Make
them Healthy,” to the Sydenham Society’s _Biennial Retrospect of
Medicine_, and to many other publications.

       *       *       *       *       *

Aural surgery has not long been raised to the rank of an honoured
specialty. JOSEPH TOYNBEE was told on one occasion by an eminent
member of the profession that he would make nothing of aural surgery.
He replied, “I will work at it for ten years, and then if nothing can
be made of it, I will tell you why.” On another occasion he said,
“I’ll rescue aural surgery from the hands of the quacks” (_Medical
Times_, July 14, 1866). Prematurely cut off though he was, he added
largely to the scientific knowledge of the ear and its maladies, and
vastly improved their treatment.

JOSEPH TOYNBEE was born in 1815, at Heckington, in Lincolnshire,
his father having been a large farmer. After being for some years
under a private tutor at home, he went to King’s Lynn Grammar
School. At seventeen he was apprenticed to Mr. William Wade of the
Westminster General Dispensary, Soho, and studied anatomy under Mr.
Dermott. His assiduous and careful dissections were of essential
benefit in preparing him for his lifelong minute dissections of
the ear in health and disease. He further studied at St. George’s
and at University College hospitals. Even during his student life
aural studies powerfully attracted him, and as early as 1836 several
letters of his under the initials J. T. appeared in the _Lancet_.
In 1838 he became a member of the College of Surgeons, and was
selected as assistant-curator of its museum under Professor Owen. He
obtained the Fellowship of the Royal Society in 1842 for researches
demonstrating the non-vascularity of articular cartilage, the cornea,
crystalline lens, vitreous humour, and epidermoid appendages, which
were published in the Philosophical Transactions for 1841.

Toynbee early entered upon aural practice in Argyll Place,
becoming also one of the surgeons to the St. James’s and St.
George’s Dispensary. He was included in the first list of Fellows
of the College of Surgeons on the issue of its new charter. At
the Dispensary he founded a Samaritan Fund for supplying the sick
poor with necessaries of life and warmth. All sanitary matters
were subjects of his profound interest, and he spent much time
in improving the condition of things in the parishes around him,
especially promoting means of securing adequate ventilation, and the
erection of model lodging-houses near Broad Street, Golden Square.

Toynbee’s practice gradually became very large, but he continued to
dissect, and also to support administratively as well as pecuniarily
many benevolent societies. He found that so little was really known
of the diseases of the ear from actual dissection, that his only hope
of framing a system of aural surgery was by personal and persevering
examination and record of morbid specimens. This was carried on for
more than twenty years, until he had dissected about 2000 human ears.
Many of these were derived from his patients in the large Asylum for
the Deaf and Dumb, whose condition he had examined previously to
their death. Many medical men also supplied him with specimens of
diseased ears, as well as notes of cases. He further inquired closely
into the history of very many cases of patients with diseased ears.

In 1860 Toynbee published an extended work on “The Diseases of the
Ear,” which placed the subject on a firm basis, and will always
remain of great value from the interesting details of cases and
treatment which it contains. The list of his own published papers
on which it is based, about sixty in number, testifies to Toynbee’s
great industry in research. They include papers on the structure and
functions of the tympanic membrane, on the muscles which open the
Eustachian tube, and on the mode of conduction of sound from the
tympanic membrane to the labyrinth of the ear, contributed to the
Royal Society, many researches on the diseases of the ear in the
Medico-Chirurgical Transactions, and a crowd of series of cases or
special memoirs contributed to the Pathological Society and medical
journals. In 1857 he had published a descriptive catalogue of the
preparations illustrating diseases of the ear contained in his own
museum.

On the establishment of St. Mary’s Hospital, Mr. Toynbee was elected
aural surgeon and lecturer on diseases of the ear; and he published
in 1855 and 1856 courses of clinical lectures, which he delivered
there. He took a deep interest in the condition of idiots, and of the
deaf and dumb, and in many cases, to his great delight, devised plans
by which those who were not totally deaf were taught to speak when
their case had been regarded as hopeless, causing a corresponding
improvement in their mental faculties.

Two of his most zealously pursued hobbies were ventilation, and
the formation of local museums. It was said that patients who went
to him for the benefit of their hearing, whether they improved in
that respect or not, came away full of the most advanced views
on ventilation. At Wimbledon, where he took a country-house, he
was indefatigable in developing a village club, and in forming an
educative and recreative museum. He published valuable “Hints on the
Formation of Local Museums” (1863), as well as “Wimbledon Museum
Notes.” His enthusiastic advocacy was actively engaged in furthering
the establishment of similar clubs and museums in various parts of
the kingdom. He continued through life an active microscopist and
zoologist, and was elected just before his death President of the
Quekett (Microscopical) Club. At the same time he was treasurer of
the Medical Benevolent Club, to which he himself largely contributed.

One of Toynbee’s most valuable contributions to the treatment of
deafness was his invention of a method of forming an artificial
tympanic membrane when that part had been destroyed or perforated.
This is fully described in his pamphlet on the subject, which went
through many editions, as well as in his general treatise. He first
demonstrated the existence of many osseous and other tumours of the
parts of the ear and of the ossicles of the tympanum, and also the
fact that the Eustachian tube leading from the back of the throat
into the tympanum remains always closed except during the momentary
act of swallowing.

A premature end came to Toynbee’s energetic and benevolent life.
Always active in experimental research, and much concerned in
aural therapeutics, he experimented on himself with chloroform,
and it is believed, prussic acid vapour, which he wished to cause
to enter by the Eustachian tube into the tympanum for the relief
of tinnitus aurium or noises in the ears. He unfortunately pursued
his experiments while alone, and was found dead on July 7, 1866, in
his consulting room at Savile Row, with a pad of cotton wool over
his face, and chloroform and prussic acid bottles, his open watch,
and various memoranda of experiments near him. His death excited
universal sympathy for Mr. Toynbee’s widow and nine children, with
whom he had lived most happily.

       *       *       *       *       *

If one great aural surgeon became a martyr of science, another was no
less a martyr of philanthropy. The name of JAMES HINTON, which gained
wide celebrity during his lifetime, has been progressively elevated
since his death by the publication of his “Life and Letters,” by Miss
Ellice Hopkins, and of his works on “The Art of Thinking,” 1879,
“Philosophy and Religion,” 1881, and “The Law-Breaker, and the Coming
of the Law,” 1884. Even yet, fortunately, much more may be hoped for,
in the shape more especially of an autobiography, and of a work on
Ethics.

It has become increasingly evident that James Hinton was, if not
a true genius, a man who approached very nearly to that altitude
of nature. As Mr. Shadworth Hodgson remarks in the introduction to
the “Chapters on the Art of Thinking,” Hinton is a hander-on of
Coleridge’s torch, with less of systematic theology and more of
emotional spiritualism. It is quite impossible to attempt here to
sketch his various philosophical contributions. Indeed the time has
not yet fully come to estimate them, their influence, or the man who
gave birth to them. As an aural surgeon he perhaps scarcely rose to
Toynbee’s level, but this was rather because the greatness of his
mind and soul in vaster fields overpowered him, than from defect of
ability. An outline of his life and work only can here be given.

James Hinton was the third child (of eleven) of the well-known
Baptist minister, John Howard Hinton, having been born at Reading in
1822. His father’s mother was aunt to Isaac Taylor, the author of
the “Natural History of Enthusiasm.” It was from his mother, Eliza
Birt, however, that James Hinton derived most. She is described as a
fervent, lofty-souled woman, full of enthusiasm and compassion, yet
dignified and able to rule others with mild but irresistible sway.

As a little child, James Hinton, though sweet-tempered, showed a
strong tendency to investigate everything, and to rearrange the
elder children’s games “as they ought to be.” The father taught the
children to be keenly observant of natural history. The mother bred
them up to have an instinctive feeling for religion, especially in
its aspect of love to God. An elder brother, Howard, died when James
was but twelve, and this bereavement made such an impression upon him
that he soon after was baptized and publicly received as a member of
the Baptist Church.

At school James Hinton did not show special ability, though he had
a remarkable verbal memory until a certain period, when he suddenly
lost it without any special cause. In 1838 his father left Reading
for London, becoming minister of the Devonshire Square Chapel.
Feeling some pressure of circumstances with his large family, Mr.
Hinton placed James in the first situation which presented itself,
viz., that of cashier at a wholesale woollen-draper’s shop in
Whitechapel. This temporary immersion in proximity to some of the
coarsest scenes imaginable had a very deep influence in educing the
thoroughgoing altruism which afterwards characterised him.

After holding the Whitechapel situation about a year, and spending
some time in search of a more suitable occupation, Hinton became a
clerk in an insurance office in the city. Here, while not becoming
an adept at book-keeping, he sat up at night and gave himself a
miscellaneous education. At this time he has been described as
“an abstract idea untidily expressed;” he was wholly indifferent
to appearances, and his clothes could never be made to fit him;
and he was often guilty of lapses from politeness. He was full of
argumentativeness, and determined to get to the bottom of everything.

A little later his intense intellectual labours, combined with the
deep sense he now and ever after entertained of the wrongs to which
women were subjected, brought him into a state of mind in which he
resolved to run away to sea. His intention being discovered, his
father consulted a doctor about him, who wisely advised that he
should enter the medical profession, as being more fitted to give
scope for his mental powers. He was consequently entered at St.
Bartholomew’s Hospital at the age of twenty. He was able to perform
his entire course of medical study with very great rapidity, and
before taking his diploma went on a voyage to China and back as
surgeon of a passenger ship. On his return in 1847 be became a member
of the College of Surgeons, and settled for a time as a surgeon’s
assistant at Newport in Essex.

He did not remain here long, but in the autumn of 1847 took the
position of surgeon to a shipload of freed slaves who were to be
shipped by voluntary agreement from Sierra Leone to Jamaica. He
remained for more than a year after this in Jamaica, taking the
practice of a medical man in ill-health, and looking after the
progress of his late charges. In 1849-50 he travelled homewards by
way of New Orleans, where he gained further insight into the slavery
question. In 1850 he entered into partnership with a Mr. Fisher, a
surgeon in general practice in Bartholomew Close; and became engaged
to Miss Margaret Haddon, after an attachment of ten years.

In August 1850 we find the first note of his success in aural
surgery; he cured his mother’s deafness by a syringing properly
performed. Some other cases of success followed this, and were very
cheering. Soon after this he was introduced to Mr. Toynbee, and spent
much time with him both at St. Mary’s Hospital and privately. Yet
he did not find anything in practice large enough to satisfy his
aspirations. “Too many things crowd upon me; none _commands_ me,”
he writes March 1851. “The thing which shall fill my heart must be
not for myself but for others. To be contented I must toil not for
comfort, nor money, nor for fame, nor for love, but for truth and
righteousness.”

In 1852 Hinton’s marriage with Miss Haddon took place, one of
singularly deep affection. He was now in practice for himself,
finding general practice not very profitable, especially as he
would not condescend to use arts to obtain success. He continued
his study of aural surgery, and assisted Mr. Toynbee largely in the
classification of his museum, already alluded to.

In 1856 Hinton published his earliest papers on physiology and ethics
in the _Christian Spectator_. In 1858 he contributed an essay to the
_Medico-Chirurgical Review_ on “Physical Morphology,” suggesting that
organic growth takes place in the direction of least resistance—a
conception utilised by Mr. Herbert Spencer in his “First Principles.”
In 1859 “Man and his Dwelling-place” was published and favourably
received. Its success encouraged him to lay aside practice, reduce
his expenses to a minimum, and take to writing as a profession. He
settled in a little house at Tottenham, where his sitting-room was of
such dimensions that he used to say he could open the door with one
hand, poke the fire with the other, and had nature given him a third,
open the window with it, without rising from his seat.

At first success attended the venture. Thackeray accepted for the
_Cornhill Magazine_ the series of “Physiological Riddles,” with the
remark “Whatever else this fellow can do, he can write!” These were
afterwards published, with others, under the title “Life in Nature.”
“Thoughts on Health” were also contributed to the _Cornhill_. But his
mind continued in such activity of growth, ever full, ever changing,
that he had not time to write his thoughts in form for publication,
and he was forced back into practice, which he had not quite
renounced, continuing to see a few aural patients twice a week at
his father’s house. In 1863 he was appointed aural surgeon to Guy’s
Hospital, and took a house in George Street, Hanover Square, for the
purpose of aural practice. With heroic and costly resolution, knowing
he could not adequately do his work as an aural surgeon and devote
himself to philosophy, he locked his manuscripts away from his sight.

Henceforward he rapidly succeeded in practice. In 1866 he took the
place vacated by the death of his valued friend Toynbee, removing to
his house in Savile Row. When in full practice, and not allowing
himself to write, his chief life was in conversation. A few lines may
be here quoted from Miss Hopkins’ Life of Hinton. “It is difficult to
give any adequate idea of the charms of Mr. Hinton’s conversation to
a mind at all in harmony with his own. His most marked peculiarity
was the intensely emotional character of his intellect. Nature to him
was no cold abstraction, no cunningly contrived machine made up of
matter and force, but a mighty spiritual presence, a living being,
tenderly and passionately beloved. The laws of nature were to him the
habits of a dear and intimate friend.... But keen as was his delight
in purely intellectual operations, he valued everything chiefly,
if not only, in its relation to the moral.... How often, from some
comparatively remote region of thought, or of art, would he flash
down a light upon some practical matter, showing perhaps a neglected
duty in its vital relations, or revealing an order in what looked
like moral waste and confusion. Owing to this strong recognition of
the spiritual unity of all life, never was there a man in whom the
barrier between the religious and the secular was more completely
effaced.”

In 1869 his success in aural surgery was so assured, that an eminent
surgeon suggested to Mr. Hinton that he might justifiably resume his
philosophy as an evening recreation. So after six years’ abstinence
he resumed his writing. But his thoughts, allowed once more to spring
into full activity, were certain to master him. “Wherever he was, at
a friend’s house, in the street, at church, at a concert, he jotted
down his notes on scraps of paper, backs of envelopes, bills, and
programmes, writing them out in full in the evening.” Finally, these
thoughts were printed for his own private use, and from them a great
portion of his posthumous works is derived.

At last he had made money enough by practice to retire. His parting
gift to his profession was contained in “The Questions of Aural
Surgery,” a work of standard value; and his “Atlas of Diseases
of the Membrana Tympani.” In March 1874 he retired, but with a
constitution deeply injured by overwork and excess of feeling and
thought. His father had died the year before; his mother died in
1874. He continued incessantly working, writing, thinking, studying
mankind in the streets and alleys of London, or in the colliers’
cottages in South Wales, and came to suffer much from sleeplessness.
When he set sail in the autumn of 1875 for the Azores, where Mrs.
Hinton had preceded him, he was already seriously ill. At last he
was seized with inflammation of the brain, and died on December 16,
1875, a martyr to his intense passion for the good of mankind. Of
his intellectual, ethical, and religious views this is not the place
to speak at large; his books must be left to explain themselves to
kindred spirits.


FOOTNOTES:

[23] Reprinted by the Association for the Advancement of Medicine by
Research, 1882.




CHAPTER XXVII.

_SIR R. CHRISTISON, SWAINE TAYLOR, AND POISON DETECTION._


Although the detection of crimes of poisoning is but one of the
departments of service which the medical profession is able to render
to the law, yet it is one which has very largely attracted public
attention, owing to the many awful aspects of death by poisoning,
and the helplessness which mankind has always felt in regard to
these crimes. Latterly the skill displayed in the detection of the
existence of poisons after the death of the victims has set at
rest many of the doubts as to the certainty of judgment in regard
to poisoning, and the discovery of antidotes to many poisons has
supplied a means of remedy in numerous cases before it is too late.
It is obvious that these results could only begin to be realised when
chemistry had made considerable progress; and consequently it was not
till 1813 that a young doctor, the celebrated Orfila, published in
Paris the first part of a treatise on Poisons, which was subsequently
merged in his “Legal Medicine,” 1821-3. The names most conspicuous in
founding this new department of investigation in Great Britain are
those which stand at the head of this chapter.

       *       *       *       *       *

ROBERT CHRISTISON, one of the twin sons of Alexander Christison,
many years Professor of Humanity in Edinburgh University, was born
at Edinburgh in July 18, 1797. After a complete education, in arts
at the University, he finally chose the medical profession, and was
for two years and a half resident assistant in the Royal Infirmary.
Taking his M.D. degree in 1819, he spent the next eighteen months at
St. Bartholomew’s Hospital, London, and in Paris, where he worked
in the laboratory of Robiquet at practical chemistry, and studied
toxicology with Orfila himself.

When Dr. Christison was about to leave Paris, Dr. Gregory’s death
led to a vacancy in the Chair of Medical Jurisprudence at Edinburgh,
and Christison was proposed to fill it while still absent. It is
significant of the state of knowledge that not one of the candidates
besides Christison had any practical knowledge of chemistry. The
influence of Lord Melville, however, who had been his father’s
resident pupil when young Christison was born, was the determining
cause of his success in the election.

At first students were very few, not half-a-dozen attending the
earliest course. Christison devoted himself with characteristic
energy to make his chair a real influence in the university. And here
we may remark briefly on the extraordinary vigour of constitution
which the new professor possessed, and retained almost till death. He
could walk, run, or row better and with more endurance than any man
of his time in Edinburgh, and that is saying a great deal. He made
his new chair his primary object. Being an extremely neat and clean
worker in the laboratory, his investigations soon became noted, and
it was found, when he was called in to give evidence on matters of
medical jurisprudence, especially in poisoning cases, that his mind
was equally clear and accurate, and that he could give reasons for
his beliefs which rendered his statements unimpeachable. From the
famous trial of Burke and Hare in 1829 down to 1866 Dr. Christison
appeared as a scientific witness in almost every case of medico-legal
importance in Scotland, and in many in England.

“As a witness,” says the _Scotsman_ (Jan. 28, 1882), “he was
remarkable for a lucid precision of statement, which left no shadow
of doubt in the mind of court, counsel, or jury as to his views.
Another noteworthy characteristic was the candour and impartiality he
invariably displayed, and which, backed as it was by the confidence
that came of mature deliberation, rendered him almost impregnable to
cross-examination. This was notably illustrated in the celebrated
Palmer trial. Some of the medical witnesses for the Crown had got so
severely handled by the prisoner’s counsel that the case seemed in
danger of breaking down, but Christison had not been long in the box
when the lawyers found they had at last met one who was a match for
the subtlest of them: and so complete was the failure of all their
efforts to discredit his evidence, that the case, by the time he
finished, had assumed the gravest possible complexion.”

As a persevering experimentalist, Christison was daring even to
rashness in making trials on himself. He thus tested the taste of
arsenious acid, which was held by Orfila and most others to be rough
and acrid, and which he proved to be rather sweet. He ate an ounce
of the root of _Œnanthe crocata_, which had stood most poisonous in
England and on the Continent; but the Scotch specimen at any rate did
not poison Dr. Christison. A most striking risk was run in the case
of the Calabar bean. He took a dose before going to bed, and found
its effects resembled those of opium. Not satisfied, he took a larger
dose next morning on rising, with the result of almost paralysing
him. But he fortunately had a good emetic close at hand, a bowl of
shaving water, and administering a large quantity, he was partially
relieved. But much prostration remained, and medical assistance had
to be summoned.

Christison’s principal services to the literature of his subject
consisted in his work on Poisons, which was first published in 1829,
and went through several successive editions, and in numerous memoirs
and papers contributed to medical and scientific journals, some of
which detailed improved chemical processes and tests for poisons,
as those on “The Detection of Minute Quantities of Arsenic in Mixed
Fluids,” “On the Taste of Arsenic, and on its Property of Preserving
the Bodies of Persons who have been Poisoned with it,” and on the
poisonous properties of numerous vegetable alkaloids.

In 1832 Christison, having raised his class to no fewer than ninety
students, resigned his chair on appointment to that of Materia
Medica, intending to become, in addition to a clinical teacher of
medicine, an original investigator on the therapeutical action of
remedies. But before he had got fully afloat in this, practice, for
which he had not specially laid himself out, flowed in upon him, and
prevented the realisation of his desire. He accumulated a fine museum
of materia medica, and his lectures were very popular. But it cannot
be said that he left his mark on medicine or therapeutics to the same
extent that he did on toxicology.

Christison was eminently a lover of his university, and exceedingly
conscious of its great merits. In numerous matters he was very
conservative, and strongly resisted some modern views of pneumonia
and fevers. He wielded great influence for many years in the
administration of university matters. In 1838 and in 1846 he was
President of the Edinburgh College of Physicians. From 1868 to 1873
he was President of the Royal Society of Edinburgh. From 1857 to 1873
he occupied a seat at the General Medical Council. After having been
for many years Physician-in-Ordinary to the Queen in Scotland, Dr.
Christison received a baronetcy in 1871, on the recommendation of Mr.
Gladstone. In the same year his bust by Brodie was presented to the
university, by general subscription among the medical profession.

In 1872 Sir Robert Christison completed his fiftieth year of active
service as professor in the university, the only case of the kind
that had ever occurred; and a large and enthusiastic assembly
entertained him at dinner. Further honours still awaited him; he was
in 1875 elected President of the British Medical Association at its
Edinburgh meeting; and in 1876 he was selected for the Presidency
of the British Association, a distinction which however he declined
on the ground of his advanced age. He soon afterwards retired from
active duty; but lived in considerable vigour till about Christmas
1881. He died on January 23, 1882, in his eighty-fifth year.

“As regards his personal characteristics,” says the _Scotsman_, “Sir
Robert was perhaps liable to be somewhat misunderstood by those who
did not know him. Dogmatic and positive in his opinions, he was
inclined to lay down the law in a way that might not always be quite
agreeable.... On the other hand, friends who had the good fortune to
know him intimately found in his nature a fund of geniality such as
the casual observer could never have dreamt of. Warmth of heart and
simple unaffected kindness would seem to have been distinguishing
qualities of his private and social demeanour.” He was a strong
Churchman and Tory. He married in 1827 a Miss Brown, who died in
1849, leaving three sons.

       *       *       *       *       *

Some years younger than Christison, ALFRED SWAINE TAYLOR was
contemporary through life with him, and occupied for many years a
quite exceptional position in the English mind in connection with the
detection of cases of poisoning. He was born at Northfleet in 1806,
and educated at Hounslow. At the early age of sixteen he became the
pupil of a surgeon near Maidstone, and in October 1823 entered as a
student at Guy’s and St. Thomas’s Hospitals, then forming a united
medical school. Later on he was exclusively connected with Guy’s as
pupil and lecturer until his retirement in 1878.

From the year 1826 Taylor gave much attention to medical
jurisprudence, although his diligence was such as to win for
him a prize for anatomy at Guy’s. Chemistry proved a congenial
subject to him under the instruction of Allen and Aikin, and he
was further stimulated in the same direction by frequent visits to
Paris and all the principal Continental medical schools. At Paris
he heard among others Orfila and Gay-Lussac. Geology, mineralogy,
and physiology likewise engaged his attention, and so was formed a
mind singularly broad in its views of natural phenomena, and well
calculated to expound their laws. Taylor passed his examinations
at the Apothecaries’ Hall in 1828 and at the College of Surgeons in
1830, and entered upon practice, continuing, however, to study in the
chemical laboratory of Guy’s Hospital.

In 1831, when the Apothecaries’ Society first required candidates for
their diploma to attend lectures on Medical Jurisprudence, Mr. Taylor
was appointed to lecture on the subject at Guy’s Hospital, a post
which he continued to hold for forty-seven years. In the next year he
succeeded Mr. Barry as co-lecturer on chemistry with Mr. Aikin, whose
colleague he continued till 1851, after which he was sole lecturer
on chemistry till 1870, when he resigned this lectureship. In these
important functions Dr. Taylor acquitted himself admirably. He was
exceedingly clear in his statements, exact and successful in his
experiments, while yet very undemonstrative in manner.

In 1832 the new lecturer commenced his long series of memoirs bearing
on poisoning, by publishing an account of the Grotto del Cane, near
Naples, with remarks on suffocation by carbonic acid. This appeared
in the _London Medical and Physical Journal_. In subsequent years
he contributed important papers to Guy’s Hospital Reports, on the
action of water on lead, on poisoning by strychnia, on the tests
for arsenic and antimony, &c., and was soon a recognised authority
on medico-legal questions. He contributed to the _London Medical
and Physical Journal_ valuable memoirs on poisoning, child-murder,
&c. In 1836 he published the first volume of a work on medical
jurisprudence which was not completed at that time. In 1842 he
brought out his well-known “Manual of Medical Jurisprudence,” which
reached its tenth large English edition in 1879, in the author’s
lifetime, in addition to numerous American editions. The Swiney Prize
of 100 guineas, together with a valuable silver vase for a work on
Jurisprudence, were also awarded to him.

In 1848, when he became a member of the College of Physicians, Dr.
Taylor published a work on Poisons which was at once accepted as
standard, and has gone through several editions. In 1865 his large
work entitled “The Principles and Practice of Medical Jurisprudence”
appeared, including much matter for which there was not space in his
manuals. This work attained its third edition in 1883, having been
edited by Dr. Thomas Stevenson, his distinguished successor at Guy’s
Hospital.

But this represents only a portion of the literary labours of Dr.
Taylor. From 1844 to 1851 he was the editor of the _London Medical
Gazette_, afterwards incorporated with the _Medical Times_. He
largely co-operated in editing various editions of Pereira’s Materia
Medica. He brought out in conjunction with Professor Brande a Manual
of Chemistry in 1863, and in 1876 edited Dr. Neil Arnott’s celebrated
work on Physics. He was elected in 1853 Fellow of the College of
Physicians, having had previously conferred upon him the honorary
M.D. of St. Andrews University. He was elected a Fellow of the Royal
Society in 1845. He married in 1834 a Miss Cancellor.

It was as a medical witness in important legal cases that Dr. Swaine
Taylor was most widely known. If a case of unusual character was
before the courts, it came to be expected that he should be called
as a witness, and for many years he was retained by the Treasury as
their medical adviser on such cases. It is impossible here to refer
to the numerous important cases of this character in which Dr. Taylor
figured. A writer in the _Medical Times_ for June 12 and 19, 1880
(pp. 642, 671), enters into this question from full knowledge, and
describes him thus: “Personally Taylor was of a tall and imposing
figure, gracious to friends and bitter to foes, and, as the lawyers
found, a superb witness, not to be shaken by any light word of
doctrine.... There was a thoroughness about Taylor’s work which was
always satisfactory.”

In regard to the celebrated Palmer trial, Dr. Taylor was severely
cross-examined, and was contradicted in important points by experts
called for the defence. In fact, it is possible that the case would
have gone in favour of the prisoner but for the strong confirmation
of the view of the prosecution given by Dr. Christison, to which we
have already referred. Dr. Taylor expressed his strong views on this
question in an extended pamphlet “On Poisoning by Strychnia,” most of
which appeared in Guy’s Hospital Reports for 1856. He died on May 27,
1880.




CHAPTER XXVIII.

_PARKES, GUY, SIMON, AND PUBLIC HEALTH._


“Prevention is better than cure” is the homely proverb which
marks out a large proportion of the work of sanitary science. The
prevention of disease and of its spread, and the promotion of the
general healthiness of the people—these are objects which modern
progress has brought into view. When they are completely attained we
shall all die of old age unless cut off by accidents or violence; and
this is a goal which many sanitarians of the present day have vividly
before their mind.

The public health and the public welfare have been sought by no man
more earnestly than by EDMUND ALEXANDER PARKES. Of him Dr. Russell
Reynolds said:[24] “In the combination of moral, mental, and physical
beauty, Dr. Parkes was to my knowledge never equalled, to my belief
cannot be surpassed. Pure as a sunbeam, strong as a man, tender as a
woman, keen as any scientist to unravel the hidden mysteries of life
in its minutest detail of chemical and physiological research, yet
practical in the application of his knowledge to the cleansing of a
drain or the lightening of a knapsack; he made the world much richer
by his life, much poorer by his death.”

Parkes was born on March 29, 1819, in the village of Bloxam,
Oxfordshire, his father being Mr. William Parkes, of the Marble-yard,
Warwick, “a man of superior mind, remarkable alike for industry,
firmness, and nobility of character.”[25] His mother, Frances Byerly,
daughter of Mr. Thomas Byerly of Etruria, Staffordshire, was much
occupied in literature, and her sister, wife of Professor A. T.
Thomson of University College, London, was a well-known biographer
and novelist.

Under such favouring influences young Parkes grew up a gentle
but unusually merry and happy boy. After being educated at the
Charterhouse, he entered as a medical student at University
College, and spent much time in his uncle’s laboratory, becoming an
excellent manipulator, and already showing a fondness for research.
At the first M.B. examination at London University in 1840 he was
exhibitioner and medallist in anatomy, physiology, and chemistry,
and medallist in materia medica. In 1841 at the final M.B. he was
medallist in physiology and comparative anatomy, and gained honours
in medicine. He had taken the College of Surgeons’ diploma in 1840.

Of this period of Parkes’s life Sir William Jenner, an intimate
fellow-student at University College, says:

“As a student he was distinguished by brightness and cheerfulness,
amiability, unselfish willingness to help others at any cost of
trouble to himself, energy in work, diligence in the using of each
hour for the studies of that hour, the high moral tone that pervaded
his converse, and above all, and crowning all, by the real living
purity of his being.”

Early in 1842 Parkes entered the army medical service, and went as
assistant-surgeon to the 84th regiment to Madras and Moulmein. Here
he prosecuted inquiries which bore fruit in two small publications
on the Dysentery and Hepatitis of India (1846), and on Asiatic
and Algide Cholera (1847). But before this period he had retired
from the army and entered upon practice in Upper Seymour Street,
Portman Square, becoming further known as a physician by editing and
completing Dr. Thomson’s work on Diseases of the Skin (1850). This
was only a portion of his literary and original work at this time,
during which he contributed largely to the _Medical Times_, and from
1852 to 1855 edited the _British and Foreign Medico-Chirurgical
Review_, for which difficult task he was exceedingly well fitted.

Having been appointed one of the physicians to University College
Hospital, his influence was very marked, both on his students and his
colleagues. One of his pupils, afterwards a distinguished physician,
said that he never went round the wards with him without feeling an
intense wish to become better, and at the same time feeling that he
could become so. In 1855 Parkes delivered the Gulstonian Lectures
at the College of Physicians, taking the subject of Pyrexia, or the
State of Fever.

During the Crimean War, when great pressure existed upon the
hospitals at Scutari, Dr. Parkes was selected by Government to
proceed to the seat of war to establish an additional large hospital.
He fixed upon Rankioi on the Dardanelles, and his choice proved
excellent. He worked most zealously to make everything as perfect as
possible, and he accomplished much in spite of the red-tape which was
so disastrously prominent in the war administration of that time. He
did not in any way spare himself, though his constitution had shown
serious signs of weakness in London, when he had had severe attacks
of pneumonia and phlebitis. His report on the work of his hospital at
the conclusion of the war was a most valuable one, and he gained the
high esteem of Mr. Sidney Herbert, afterwards Lord Herbert of Lea.

One result of the Royal Commission of Investigation into the
administration of the war was the foundation of the Army Medical
School, and Mr. Herbert never showed better judgment than in
selecting Dr. Parkes to be Professor of Military Hygiene in
connection with it. Consequently he gave up in 1860 his post at
University College; he was appointed Emeritus Professor, and a marble
bust of him was placed in the College museum.

Parkes found that in order adequately to teach the subjects involved
in preserving and promoting the health of the army, he must not only
study the special features of army life and the peculiar liabilities
attaching thereto, but also the general science of hygiene, then
almost new. He organised at the cost of immense labour a detailed
system of instruction, based on the principle of making the student
apply practically what he taught. All the special questions which
came up relating to air, water, food, temperature, clothing, house
construction, drainage, &c., were as far as possible illustrated in
the laboratory, and individual instruction was most carefully given.

In 1864 was published the first edition of Parkes’s “Manual of
Practical Hygiene,” a masterly book, accurate, learned, clear, full,
and of the highest interest to the thoughtful mind. The introduction
to this work opens with a clear definition of the subject. “Hygiene
is the art of preserving health; that is, of obtaining the most
perfect action of body and mind during as long a period as is
consistent with the laws of life. In other words, it aims at
rendering growth more perfect, decay less rapid, life more vigorous,
death more remote.”

Later he says: “It is undoubtedly true that we can, even now,
literally choose between health and disease; not, perhaps, always
individually, for the sins of our fathers may be visited upon us,
or the customs of our life and the chains of our civilisation and
social customs may gall us, or even our fellow-men may deny us
health, or the knowledge which leads to health. But, as a race, man
holds his own destiny, and can choose between good and evil; and as
time unrolls the scheme of the world, it is not too much to hope
that the choice will be for good.” He further powerfully indicates
the basis of state medicine, to secure for all individuals the
conditions of health which they often cannot secure for themselves.
He shows too that self-interest, state-benefit, and pecuniary profit
are at one in these matters when rightly understood. “It is but too
commonly forgotten,” he says, “that the whole nation is interested
in the proper treatment of every one of its members, and in its own
interest has a right to see that the relations between individuals
are not such as in any way to injure the well-being of the community
at large.” It is almost needless to add that numerous editions of
Parkes’s Practical Hygiene have been called for; it has also been
translated into several foreign languages.

We have enumerated, however, but a small portion of the subjects
upon which Parkes’s unceasing philanthropic activity was exercised.
For many years he wrote an annual review of the Progress of Hygiene,
contributed to the Army Medical Reports. He served on many public
inquiries relating to matters of health, and did more for the
diminution of mortality in the army than any other man. He carried
on many protracted and difficult physiological investigations, such
as those on the effects of diet and exercise, on the elimination of
nitrogen, on the effects of alcohol on the human body, on the effects
of coffee, extract of meat, and alcohol on men marching, chiefly
contributed to the Royal Society. As a member of the Senate of London
University, and of the General Medical Council, and as Secretary to
the Senate of the Army Medical School, he performed detailed work of
the highest value, and all in spite of delicate health.

“With increase of years,” says Sir William Jenner,[26] “his mind
ripened, his sphere of action widened, his influence over others
operated in new and perhaps more important ways; but in all moral
and intellectual essentials Dr. Parkes was as a man what he was
as a youth—he was animated by the same principles and stimulated
by the same faith. As years went on his mind proved itself to be
singularly well balanced; he possessed an extraordinary power of
acquiring information; his memory was very retentive; he was the
best-informed man in the medical literature of the century I ever
met; he was unprejudiced as he was learned; he could use with ease
the information he acquired, and could express his ideas clearly and
simply; his language was always elegant, and on occasions eloquent.
His powers of observation, of perception, of reasoning, and of
judgment were all good, and equally good. But as in his youth,
so in his manhood, the beauty of his moral nature, his unselfish
loving-kindness, his power of inoculating others with his own love
of truth, with his own sense of the necessity of searching for the
truth, of questioning nature till she yield up the truth, of earnest
work, were his most striking characteristics.”

At last the seeds of weakness which were constitutional in Parkes
developed into acute tuberculosis, and he died on March 15, 1875,
after an illness of four months. His domestic life had been a very
happy one, but his wife, a Miss Chattock, whom he married in 1851,
had died in 1873, and he was much broken by her loss. He left no
children. His monument is in the Parkes Museum of Hygiene, which
enforces eloquently the lessons of his life.

       *       *       *       *       *

Dr. WILLIAM AUGUSTUS GUY, F.R.S., is one of the most eminent of
modern promoters of the public health. He was born at Chichester
in the year 1810, his ancestors for three generations having been
medical practitioners there. His grandfather, William Guy, was a
pupil of John Hunter, and in Hayley’s life of Romney it is stated
that “Cowper said of him that he won his heart at first sight, and
Romney (who painted his portrait) declared that he had never examined
any manly features which he would sooner choose for a model if he had
occasion to represent the compassionate benignity of the Saviour.”[27]

After a childhood spent with this estimable grandfather, young Guy
was educated at Christ’s Hospital, and later studied for five years
at Guy’s Hospital. Winning the Fothergillian medal of the Medical
Society of London for the best essay on Asthma, in 1831, at the early
age of twenty-one, he was encouraged to enter at Cambridge, where,
after a further period of two years spent at Heidelberg and Paris, he
took his M.B. degree in 1837.

In 1838 Dr. Guy became Professor of Forensic Medicine in King’s
College, London, and later Assistant-Physician to King’s College
Hospital. He early directed his attention to statistics, and joined
the Statistical Society in 1839, and became one of its honorary
secretaries in 1843. 1844 he contributed important evidence
before the Health of Towns Commission, on the state of the London
printing-offices, and the consequent development of pulmonary
consumption among printers. He co-operated in founding the Health
of Towns Association, and has been incessantly occupied in public
lectures, investigations, and writings, in calling attention to
questions of sanitary reform. He has been notably concerned in the
improvement of ventilation, the utilisation of sewage, the health
of bakers and soldiers, hospital mortality, and many other like
subjects. In 1873 he was President of the Statistical Society, and he
has successively been Croonian, Lumleian, and Harveian Lecturer at
the College of Physicians. His various publications and papers are
too numerous to recount. We may, however, mention the “Principles of
Forensic Medicine,” and successive editions of Hooper’s “Physicians’
Vade Mecum.”

       *       *       *       *       *

Mr. JOHN SIMON, C.B., F.R.S., is one of the veterans of the present
day in matters of public health, besides having the highest
reputation as a surgeon and pathologist. Born in 1816, Mr. Simon was
a student of King’s College, London, and was elected a fellow of the
College of Surgeons in 1844. He was appointed in 1847 lecturer on
Pathology at St. Thomas’s Hospital. His subsequent researches and
writings, especially those on Inflammation, have proved his great
fitness for the post. In 1850 he published a very original course of
lectures on General Pathology, as conducive to the establishment of
Rational Principles for the Diagnosis and Treatment of Disease.

Mr. Simon’s career in connection with public health began with his
being appointed the first Medical Officer of Health to the City of
London. He was before long selected as medical adviser to the General
Board of Health, and was thence transferred to the important post of
medical officer to the Privy Council. In this capacity his labours,
ably seconded by a crowd of zealous workers, have been of priceless
value to the nation at large. The successive annual reports published
by the Privy Council sufficiently attest this.

In his first report to the Privy Council, Mr. Simon stated “that
more than half of our annual mortality results from diseases which
prevail with a very great range of difference in proportion as
sanitary circumstances are bad or good; that, according to the latest
available evidence, some of these diseases prevail twice or thrice,
some of them ten or twenty times, some of them even forty or fifty
times, as fatally in some districts as in other districts of England;
that the result of their excessive partial development is to render
the mortality of certain districts from 50 to 100 per cent. higher
than the mortality of other districts, and to raise the death-rate of
the whole country 33 per cent. above the death-rate of its healthiest
parts.”

In his eleventh report Mr. Simon was able to write as follows: “It
would, I think, be difficult to over-estimate, in one most important
point of view, the progress which, during the last few years, has
been made in sanitary legislation. The principles now affirmed in
our statute-book are such as, if carried into full effect, would
soon reduce to quite an insignificant amount our present very large
proportions of preventable disease.... Large powers have been given
to local authorities, and obligation expressly imposed on them,
as regards their respective districts, to suppress all kinds of
nuisance, and to provide all such works and establishments as the
public health primarily requires; while auxiliary powers have been
given for more or less optional exercise in matters deemed of less
than primary importance to health.... The State ... has interfered
between parent and child ... between employer and employed ...
between vendor and purchaser; has put restrictions on the sale
and purchase of poisons; has prohibited in certain cases certain
commercial supplies of water; and has made it a public offence to
sell adulterated food, or drink, or medicine, or to offer for sale
any meat unfit for human food.... Its care for the treatment of
disease has not been unconditionally limited to treating at the
public expense such sickness as may accompany destitution; it has
provided that in any sort of epidemic emergency, organised medical
assistance, not peculiarly for paupers, may be required of local
authorities; and in the same spirit requires that vaccination at the
public cost shall be given gratuitously to every claimant.”

Mr. Simon has been a distinguished surgeon to St. Thomas’s Hospital,
and attained some years ago the Presidency of the College of
Surgeons. He is also a member of the General Medical Council. In 1878
his bust in marble was presented to the College of Surgeons by public
subscription, in recognition of his eminent services in sanitary
science.


FOOTNOTES:

[24] See the _Lancet_, March 25, 1876, p. 481.

[25] _Medical Times and Gazette_, March 25, 1876, p. 348.

[26] _Lancet_, July 8, 1876, p. 41, supplement to Harveian Oration.

[27] See Photographs of Eminent Medical Men, ii, 59.




INDEX.


  Abercrombie’s, Sir Ralph, Expedition, i. 182.

  Aberdeen University, i. 100, ii. 246.

  ABERNETHY, JOHN (1764-1831), i. 146, 162, 168;
    early years, 227;
    apprenticeship, 227;
    pupil of Pott and John Hunter, 228;
    appointed assistant-surgeon to St. Bartholomew’s, 228;
    his lectures, 229;
    dramatic style, 230, 231;
    his method, 232;
    apt phrases, 233;
    roughness and eccentricity, 233, 234;
    impatience, 235;
    gratitude of an Irishman, 235, 236;
    anecdotes, 236, 237;
    surgical and physiological essays, 237;
    “read my book,” 238;
    marriage, 239;
    becomes full surgeon, 239;
    failing health, 240;
    resigns appointments, 240;
    death, 241;
    Abernethy and Brodie, 289;
    and Lawrence, 303-305, 307.

  Academy of Science, French, i. 283.

  Acland, Sir H., on Brodie, i. 300-303;
    on Stokes, ii. 189, 192.

  Acupressure, ii. 102.

  Addison Family, the, ii. 1, 2.

  ADDISON, THOMAS (1793-1860), education, ii. 2;
    at Edinburgh, 2;
    settles in London, 3;
    dislike of specialism, 3;
    appointments at Guy’s, 4, 5;
    early works, 4;
    writes on practice of medicine, &c., 5;
    on disease of supra-renal capsules (Addison’s disease), 6, 7;
    clinical teaching, 7;
    his practicality, 8;
    Dr. Wilks on, 8-10, 11;
    bluntness and shyness, 10, 11;
    Continental reputation, 11;
    Dr. Lonsdale on, 12;
    marriage, 12, 13;
    death, 13;
    Addison Ward, 13;
    association with Dr. Bright, 17, 21.

  Aikin, John, on Harvey, i. 47;
    on Cullen, 95.

  Akenside, Mark, i. 99.

  Aldersgate School of Medicine, i. 279, ii. 241.

  Aldus Manutius, i. 2, 3.

  Alison, Dr. W. P., i. 105, ii. 180, 188.

  Anæsthetics, ii. 95-100.

  Anatomical Lectures, i. 18, 75-79, 84, 109, 121, 135, 138, 204, 205,
        229, 246, 289, ii. 25, 26, 36, 37, 48, 49, 73, 226.

  Anatomists, William Hunter on, i. 125.

  Anatomy in London, i. 18;
    in Edinburgh, 72, 73;
    stealing corpses for, 77;
    the resurrectionists, 208-211;
    at Royal Academy, 247.

  —— Comparative. See Comparative Anatomy.

  Anderson, Dr. James, on Cullen, i. 96, 98.

  Aneurism, i. 153, 214, ii. 44.

  Antiseptic Surgery, ii. 46, 114, 141-147.

  Arthur, Prince, i. 3.

  Aubrey on Harvey, i. 35, 38, 48, 49.


  Babington, Dr., on Brodie, i. 299.

  BAILLIE, Dr. MATTHEW (1761-1823) on William Hunter, i. 124;
    completes his uncle’s work, 128;
    his uncle’s bequests to him, 130, 132;
    at John Hunter’s death, 158;
    and Marshall Hall, 267, 269;
    his practicality, ii. 51;
    education, 52;
    assists William Hunter, 53;
    writes on morbid anatomy, 53;
    physician to St. George’s Hospital, 53;
    physician to George III., 54;
    manners and generosity, 54, 55;
    death, 55;
    bequest to College of Physicians, 55.

  Balderson, Charles, i. 208, 211, 215.

  Balfour, Sir A., i. 72.

  Barber Surgeons, i. 18, 72.

  Barclay, Dr. (anatomical lecturer), ii. 25, 35.

  Bark, Peruvian, i. 59.

  Barlow, Dr. H. C., ii. 120.

  Barlow, Dr., on Dr. Bright, ii. 14.

  Baron, Dr., Life of E. Jenner, i. 169, 200, 201.

  Bayley, Miss, i. 186.

  Bell, Benjamin, i. 109, 110.

  Bell, George Joseph, i. 243, 259.

  Bell (John Hunter’s artist), i. 145, 147, 148.

  Bell, Lady; i. 249, 258, 261-263.

  BELL, JOHN (1763-1820), and Dr. Gregory, i. 103, 105, 110;
    early years, 108;
    attacks Monro and Benjamin Bell, 109, 110:
    excluded from Infirmary, 110;
    success in practice, 111;
    operative skill, 111;
    works on anatomy and surgery, 112;
    marriage, 113;
    artistic tastes; 113;
    illness and foreign travel, 113;
    death, 114;
    Observations on Italy, 114;
    personal character, 117, 118;
    and Charles Bell, 243, 244, ii. 48, 107.

  BELL, Sir CHARLES (1774-1842), i. 108, 112, 113;
    birth and education, 243;
    medical study in Edinburgh, 244;
    early works, 244;
    goes to London, 245;
    artistic anatomy, 245;
    lectures and early struggles, 246;
    anatomy of expression, 246;
    his lively temperament, 247;
    first idea of new anatomy of brain, 247;
    disappointment of Academy professorship, 248
    visit to Haslar Hospital, 248;
    marriage, 249;
    partnership in Windmill Street School, 249;
    elected surgeon to Middlesex Hospital, 250;
    goes to Waterloo, 250;
    pamphlet on Brain, 251;
    crucial experiments on spinal cord, 252;
    publishes his discoveries on the nervous system, 253;
    elucidates obscure diseases, 254;
    muscular sense, 254;
    Bridgewater Treatise on the Hand, 255;
    becomes professor at College of Surgeons, 256;
    at London University, 257;
    retires from latter, 257;
    fly-fishing, 257;
    his happy temperament, 258;
    knighted, 259;
    elected Professor at Edinburgh, 259;
    coldness of fellow-professors, 260;
    excitement at proposed changes, 260;
    journey to London, 260, 261;
    his last day, 261;
    _Edinburgh Review_ on, 262;
    Jeffrey’s Epitaph on, 262.

  Bell, William, i. 242.

  BENNETT, JOHN HUGHES (1812-1875);
    early training, ii. 209;
    studies at Edinburgh, 210;
    studies in Paris and in Germany, 210;
    treatise on cod-liver oil, 210;
    lectures in Edinburgh, 211;
    polyclinical course, 211, 212;
    literary work, 212;
    elected Professor, 212;
    clinical teaching, 213;
    and Leucocythæmia, 213;
    views on pneumonia, 214;
    principal works, 214, 215;
    character, 215, 216;
    illness, operation, and death, 216.

  Berkeley, Admiral, and vaccination, i. 192.

  Bishops’ licenses to practise medicine, i. 10.

  Blackhall, Dr., ii. 19.

  Black, Joseph, i. 84, 90, 92, 96.

  Blane, Sir Gilbert, i. 192.

  Blicke, Sir C., i. 227.

  Blizard, Sir W., i. 144, 228.

  Booker, Rev. Dr., i. 185.

  Botany at Edinburgh, i. 72.

  Bowman, J. Eddowes, ii. 261.

  BOWMAN, Sir W. (_b._ 1816);
    early life, ii. 261;
    studies medicine at Birmingham, 261;
    at Dublin and King’s College, London, 261;
    becomes demonstrator and curator, 262;
    Continental studies, 262;
    physiological papers, 262;
    scientific writing, 263;
    appointed to Ophthalmic Hospital, 263;
    eye practice, 264;
    professorship of physiology, 264;
    baronetcy, 265;
    St. John’s House, 265;
    assist Miss Nightingale’s work, 265;
    supports physiological experiments, 265;
    lofty view of surgery, 266.

  Boyle, Robert, i. 54.

  Bridgewater Treatises, i. 255.

  BRIGHT, RICHARD (1789-1858), ii. 5;
    birth, 14;
    studies at Edinburgh and Guy’s, 15;
    journey through Iceland, 15;
    enters at Cambridge, 16;
    travels on Continent, 16, 17;
    at Waterloo, 16;
    appointments at Fever Hospital and at Guy’s, 17;
    Dr. Wilks on, 18;
    writes on kidney diseases, 18-20;
    on pneumonia, 20;
    on cerebral and spinal diseases, 21;
    practice, and death, 21;
    character, 22, 23;
    and Holland, 63, 64.

  Bristol Medical School, ii. 127.

  British Association, ii. 183.

  British Medical Association, i. 281, ii. 162, 177.

  _British Medical Journal_, ii. 154, 248, 265.

  Brodie, Alexander, i. 286.

  Brodie, Peter, i. 288.

  Brodie, Rev. Mr., i. 287.

  BRODIE, Sir BENJAMIN (1783-1862);
    ancestry, i. 286;
    birth, 287;
    early years and education, 288;
    an ensign at fourteen, 288;
    medical study in London, 288, 290;
    non-medical friends, 289;
    the Academical Society, 289;
    becomes demonstrator at Windmill Street, 290;
    appointed Assistant-Surgeon to St. George’s, 290;
    lectures on Surgery, 291;
    physiological studies, 291, 292;
    marriage, 292;
    work on Diseases of Joints, 292;
    professional success, 294;
    professorship at College of Surgeons, 294;
    subcutaneous surgery, 294;
    court appointments, and baronetcy, 295;
    opposition to impostors, 296;
    his numerous presidencies, 297;
    autobiography, 297;
    operations on his eyes, 298;
    death, 298;
    character of, 298-303;
    character of Lawrence, 308.

  Brougham, Lord, i. 246, ii. 34, 43.

  Brown, Baker, ii. 110, 111.

  Brown, Dr. John (Horæ Subsecivæ), on Sydenham, i. 59.

  Brown, Dr. John (founder of Brownian System), i. 98.

  Brown Square School, ii. 36, 37.

  Buckland, F., and John Hunter’s remains, i. 163.

  Budd, George, ii. 125.

  Budd, Samuel, ii. 125.

  BUDD, WILLIAM (1811-1880);
    early life, ii. 125;
    medical studies, 125;
    investigates typhoid fever at North Tawton, 125-126;
    germ theory, 126-128;
    removes to Clifton, 127;
    opposition to his views, 128;
    measures against cholera, 128, 129;
    against rinderpest, 129;
    his writings, 129;
    incessant work, 130;
    views on pulmonary consumption, 130;
    death, 130;
    Murchison and, 132.

  Buller, Justice, and John Hunter, i. 151.

  Burke, Edmund, i. 91.

  Byng, Dr., and Caius, i. 20.


  Cæsalpinus, i. 29.

  Caius College. See Gonville and Caius, also Caius, John.

  CAIUS, JOHN (1510-1573), builds Linacre’s monument, i. 13;
    birth, 13;
    at Cambridge, 14;
    elected fellow of Gonville Hall, 14;
    studies at Padua, and travels in Italy, France, and Germany, 14;
    practises medicine, 14;
    appointed physician to Edward VI., 14;
    writes on Sweating Sickness, 15;
    denounces quacks, 16, 17;
    elected President of College of Physicians, 17, 20;
    introduces dissection, 18;
    enlarges Gonville Hall and builds gates, 19;
    obtains statutes for Gonville and Caius College, and becomes Master,
        19;
    charged with atheism and Romanism, 20;
    books and vestments burnt, 20;
    writes on British Dogs, 21;
    account of Bloodhound, 21, 22;
    writes Method of Healing, 22;
    death and burial, 23;
    inscription on tomb, 23.

  Calvin, i. 28.

  Cambridge University, and Linacre, i. 3, 11;
    and Caius, 14, 19, 20, 23;
    and Sydenham, 60;
    and Chambers, ii. 59;
    and Watson, 149.

  Canadian Indians and Jenner, i. 194.

  Carlisle, Sir Anthony, i. 146, 155, 248, ii. 32.

  Caroline, Princess (wife of George IV.), ii. 65.

  Carro, Dr. De, i. 182.

  Carter, Elizabeth, ii. 267.

  CARTER, R. BRUDENELL (_b._ 1828);
    education, 268;
    early works, 268;
    Crimean service, 268;
    country practice, 269;
    connection with journalism, 269;
    ophthalmic specialism, 269;
    Treatise on Eye Diseases, 270;
    later writings, 270, 271.

  Celsus, i. 14.

  CHAMBERS, WILLIAM FREDERIC (1786-1855);
    education, ii. 59;
    physician to St. George’s Hospital, 59;
    physician to William IV., 60;
    death, 60;
    character and habits, 61.

  Chandler, Mr., on Astley Cooper, i. 218.

  Charles I., i. 35-39.

  Charlesworth and Lunacy, ii. 220.

  Cheselden, i. 76, 77, 120, 134.

  Cholera, ii. 128.

  CHRISTISON, Sir R. (1797-1882), ii. 42;
    education at Edinburgh, 286;
    studies in London and Paris, 286;
    appointed Professor of Medical Jurisprudence at Edinburgh, 286;
    his success in lecturing, 287;
    success as scientific witness, 287;
    dangerous experiments, 288;
    work on poisons, 288;
    appointed Professor of Materia Medica, 289;
    influence in Edinburgh University, 289;
    honours, 290;
    death, 290;
    personal characteristics, 290.

  Circulation of the blood, i. 27-36.

  Civiale’s operation, ii. 196.

  Clarke, Dr., and J. Hunter, i. 150.

  Clark, Sir James, ii. 181.

  Clay, Dr. C., ii. 109, 110.

  Clay, John, ii. 112.

  Cleopatra’s Needle, ii. 247.

  Clerke, Dr., i. 89.

  Clift, W., i. 157, 160, 168, 220.

  Cline, Henry, i. 144, 146, 180, 203, 204, 206, 212, 226.

  Clinical lectures, i. 92, 93, 103, 250, ii. 38, 172, 206, 213.

  —— medicine, ii. 162.

  COBBOLD, T. SPENCER (_b._ 1828);
    early life, ii. 255;
    studies at Edinburgh, 255;
    geological studies, 255, 256;
    appointments in London, 256;
    dissections at Zoological Gardens, 256;
    practice as a specialist, 257;
    connection with Veterinary College, 257;
    lectures on parasites, 258, 259.

  Cod-liver oil, ii. 186, 187, 210, 211.

  Colet, i. 3.

  Collyer, Robert, and anæsthetics, ii. 96, 97.

  Columbus, Realdus, i. 14, 29.

  Combe, William, i. 130, 131.

  Comparative anatomy, i. 80.

  CONOLLY, JOHN (1794-1867), ii. 160, 217;
    early life, 221;
    enters militia, 221;
    studies at Edinburgh, 222;
    practises at Chichester, 222;
    at Stratford, 222;
    appointed Professor at London University, 222;
    settles at Warwick, 222;
    studies insanity, 222, 223;
    work on Indications of Insanity, 223;
    appointed to Hanwell, 225;
    abolishes mechanical restraint, 226;
    clinical lectures, 227;
    interest in patients, 228;
    retirement from Hanwell, 228;
    at Earlswood Asylum, 229, 230;
    private practice, 230;
    writings and lectures, 231;
    writes on Hamlet, 231;
    death, 231.

  Conservative surgery, ii. 47, 71-81.

  Consumption Hospital, ii. 185.

  _Contemporary Review_, ii. 197, 198.

  Cooper, Bransby, i. 209, 221, 222.

  Cooper family, the, i. 202.

  COOPER, Sir ASTLEY (1768-1841), i. 113, 146, 152;
    early life, 202;
    escapades, 203;
    pupilage with Cline, 203;
    studies at Edinburgh, 204;
    becomes lecturer, 204;
    visit to Paris, 204;
    his style of lecturing, 205;
    a severe accident, 206;
    his personal influence, 206;
    appearance and habits, 207;
    sympathy with mental suffering, 207;
    his servant Charles, 208;
    Cooper and the resurrectionists, 208;
    their extortions, 209;
    his determination to have specimens, 210;
    dissection of dogs, 211;
    of an elephant, 211;
    income, 211;
    gives up politics on appointment to Guy’s surgeoncy, 212;
    operates on tympanic membrane, 212;
    membership of societies, 213;
    his store of information, 214;
    operations for aneurism, 214;
    work on Hernia, 214;
    life in New Broad Street, 215;
    in the hospital and lecture-room, 216;
    his overpowering influence, 217;
    graceful operations, 218;
    peremptory orders, 218;
    a big fee, 219;
    his limited pharmacopœia, 219;
    lectures at College of Surgeons, 220;
    ties the aorta, 220;
    operates on George IV., 221;
    Sir Astley as an examiner, 221;
    foundation of Guy’s separate medical school, 222;
    Presidency of the College of Surgeons, 222;
    life in the country, 223;
    horse-keeping, 223;
    temporary retirement, 223;
    later works, 224;
    rapid movements, 224;
    death, monument and portrait, 225;
    estimate of Cooper, 225;
    his own character of himself, 226;
    and Abernethy, 235;
    and Charles Bell, 248;
    and Brodie, 295, 296.

  Cooper, William, i. 203, 212.

  Cornelio Vitelli, i. 2.

  CORRIGAN, Sir DOMINIC (1802-1880);
    education and medical studies, ii. 155;
    papers on heart diseases, 156, 157;
    Corrigan’s pulse, 156, 157;
    appointments, 158;
    becomes M.P. for Dublin, 159;
    death, 159.

  Coulton, ii. 97.

  Cowley on Harvey, i. 39.

  Coxe, Dr. Thomas, i. 53.

  Cremation, ii. 116, 117, 194, 198, 199.

  Cromwell, i. 73.

  Cruickshank, i. 127, 130, 149.

  CULLEN, WILLIAM (1710-1790);
    birth, i. 87;
    education at Glasgow, 87;
    apprenticeship, 88;
    goes to West Indies as ship’s surgeon, 88;
    assists in a London shop, 88;
    begins practice, 88;
    receives a legacy, 88;
    further studies at Edinburgh, 88;
    friendship of Duke of Hamilton, 89;
    influences William Hunter, 89;
    marriage, 89;
    removal to Glasgow, 89;
    founds medical school there, 90;
    his lectures and discoveries, 90, 91;
    becomes Professor of Medicine at Glasgow, 91;
    friendship with Adam Smith and David Hume, 91;
    appointed Professor of Chemistry at Edinburgh, 91;
    his clinical lectures, 92;
    his candour, 92, 93;
    letter to his son, 94, 95;
    appointed to Chair of Physic, 95;
    his works, 96;
    personal influence, 96, 97;
    kindness to students, 97;
    Cullen and John Brown, 98;
    death, 98;
    personal aspect and habits, 98;
    agreement with Gregory, 100;
    friendship with William Hunter, 91, 94, 120, 122.

  Czermak, ii. 251.


  Dancaster, William, i. 13.

  Darwin, Charles, anticipation of, i. 172.

  Davy, Sir Humphrey, i. 172, ii. 95, 96.

  Dogs, Caius on, i. 21.

  Donders, ii. 260.

  Donellan, Captain, trial of, i. 150.

  Douglas, Dr., i. 120, 121.

  Down, Dr. Langdon, on Conolly, ii. 229.

  Drummond, George, i. 78.

  Dublin Medical School, ii. 105, 155, 189-191, 201-208.

  Duncan, Dr., on Monro _secundus_, i. 85, 86.


  Edinburgh University and Medical School, i. 71-118, 204, 213, 224,
        259, 260; ii. 2, 15, 25-28, 35-50, 56, 59, 63, 64, 73, 85-94,
        99-103, 125, 130, 131, 138, 149, 155, 204, 210-216, 221, 222,
        286, 289.

  Edward VI., i. 14.

  Elizabeth, Queen, i. 14, 18, 23.

  Elliot, Robert, Professor of Anatomy at Edinburgh, i. 75.

  Ent, Sir G., i. 40, 41.

  Erasmus, i. 3, 4, 5.

  Esquirol and lunacy, ii. 220.

  Expectant treatment, i. 59.


  Fabricius, i. 26, 29.

  Faraday, ii. 96, 181.

  FERGUSON, Sir WILLIAM (1808-1877), and conservative surgery, ii. 71,
        72;
    early years, 72;
    studies anatomy under Knox, 72, 73;
    assists Knox, 73;
    his Edinburgh appointments, 73;
    removal to London, 74;
    operative skill, 74, 75;
    conservation of limbs, 75;
    lithotomy, 76;
    excision of joints, 76, 77;
    hare-lip and cleft-palate, 77;
    invents instruments, 78;
    careful planning of operations, 78, 79;
    “Practical Surgery,” 79;
    social character and manners, 80-82;
    appointments, 81;
    President of College of Surgeons, 81;
    death, 82.

  Fever Hospital, London, ii. 118, 119, 124, 131, 132.

  Fevers, Sydenham’s method of curing, i. 54;
    treatment of, 64.

  Fisher, Robert, i. 3.

  Flogging of Soldiers, i. 281.

  Flourens, i. 283.

  Foot, Jesse, on John Hunter, i. 135.

  _Fortnightly Review_, ii. 240, 253.

  Fothergill’s, Dr., collection, i. 130.

  Fox, Bishop of Winchester, i. 4, 11.

  Framingham, William, i. 16.

  French Academy of Sciences, i. 283.

  Fuller, on Caius, i. 20.


  Galen, i. 7, 8, 14.

  Gardner, E., i. 173, 176, 178.

  Garthshore, Dr., i. 139, 162.

  Generation, Harvey on, i. 34, 39-43.

  George III., i. 127, ii. 54, 57.

  George IV., i. 221, 295, ii. 57.

  Gerhard, Dr., of Philadelphia, ii. 120.

  Germ Theory of Typhoid, ii. 126, 127.

  Gesner and Caius, i. 21.

  GILBERT, WILLIAM (1540-1603), i. 23, 24;
    physician to Queen Elizabeth, 23;
    writes on the magnet, 24.

  Glasgow University, i. 87, 89, 120, 122, 128.

  Gonville and Caius College, i. 19, 26.

  Gonville Hall, i. 14, 19.

  Goodsir, John, ii. 47, 255.

  GRAVES, R. J. (1795-1853), ii. 189;
    studies at Dublin, London, and Edinburgh, 202;
    travels on Continent, 202;
    intercourse with Turner, 202;
    decision when in danger, 203;
    description of, by Stokes, 203;
    appointments in Dublin, 204, 206;
    introductory lecture, 204;
    his clinical method, 205;
    lectures on physiology, 206;
    clinical lectures, 206;
    Trousseau’s opinion, 206, 207;
    views on fevers, 208;
    on cholera, 208;
    death, 209.

  Gregory family, i. 87, 99-108.

  Gregory, Henry, on Marshall Hall, i. 277.

  GREGORY, JAMES, Dr. (1753-1821), on Monro _secundus_, i. 83;
    early years, 102;
    completes his father’s lectures, 102;
    studies on the Continent, 102;
    practice, 103;
    Gregory’s “Conspectus,” 103;
    succeeds to Cullen’s chair, 103;
    controversies, 103-105;
    Gregory and John Bell, 105, 110, 112;
    as a teacher and lecturer, 106;
    autocracy, 103-107;
    philosophical writings, 107.

  GREGORY, JOHN (1724-1773), i. 95;
    early years, 99;
    studies at Edinburgh, 99;
    at Leyden, 99;
    elected professor at Aberdeen, 100;
    marriage, 100;
    settles in London, 100;
    recalled to Aberdeen, 100;
    removes to Edinburgh, 100;
    works, 101;
    death, 102.

  Gregory, William, i. 107.

  Grocyn, i. 3, 7.

  GULL, Sir W. W. (_b._ 1816);
    studies at Guy’s Hospital, ii. 159;
    appointments at Guy’s, 160;
    writings, 161;
    protest against specialism, 161;
    address to British Medical Association, 162;
    Harveian oration, 162, 163;
    honours, 163, 164;
    evidence on intemperance, 164;
    view of vivisection, 165, 166.

  Guy, William, ii. 302.

  GUY, W. A. (_b._ 1810);
    education, ii. 302;
    studies at Guy’s, Cambridge, and on the Continent, 303;
    appointed professor at King’s College, London, 303;
    studies statistics, 303;
    sanitary reforms, 303;
    works, 303.

  Guy’s Hospital, i. 202-222, 225, ii. 3-13, 15-21, 159-161, 282, 291.

  Guy’s Hospital Reports, ii. 10, 18, 20, 21, 161, 294.


  HALFORD, Sir HENRY (1766-1844);
    on Baillie, ii. 51;
    education, 56;
    physician to Middlesex Hospital, 56;
    physician to George III., 57;
    change of name, 57;
    president of College of Physicians, 58;
    writings, 58.

  HALL, MARSHALL (1790-1857);
    birth, i. 264;
    education and apprenticeship, 265;
    study at Edinburgh, 265;
    lectures on diagnosis, 266;
    Continental study, 267;
    practice in Nottingham, 267;
    work on Diagnosis, 267;
    on Symptoms and History of Diseases, 268;
    on Loss of Blood, 268;
    antagonism to bleeding, 268;
    removes to London, 269;
    rapid success, 269;
    research on circulation refused by Royal Society, 270;
    other papers accepted, 270;
    study of hybernation, 271;
    accident to a manuscript, 271;
    research on reflex actions, 272-276;
    application to nervous diseases, 273, 274, 276, 277;
    persistent attacks on, 274, 275;
    second paper rejected by Royal Society, 274;
    researches on galvanism and nervous tissues, 275;
    replies to mis-statements, 275, 276;
    new memoir on Nervous System, 276;
    Ready Method in Asphyxia, 277;
    his demeanour in practice, 278, 279;
    lectures, 279;
    at College of Physicians, 280;
    British Medical Association, 281;
    philanthropic schemes, 281;
    visit to America, 282;
    writes on Slavery, 282;
    Continental tour, and reception in Paris, 283;
    suggestions for restoring the apparently drowned, 284;
    painful illness and death, 285.

  Hall, Mrs. Marshall, i. 276.

  Hall, Robert, father of Marshall, i. 264.

  Hall, Samuel, brother of Marshall, i. 265.

  Hamilton, Duke of, i. 87, 89, 90.

  Harrison, Treasurer of Guy’s, i. 212, 222, ii. 3.

  Harveian Oration, i. 25, 45, 86, ii. 162.

  HARVEY, WILLIAM (1578-1657);
    birth, i. 26;
    at Cambridge and Padua, 26;
    settles in London, 26;
    physician to St. Bartholomew’s, 27;
    Lumleian lecturer, 27;
    expounds new views on heart and circulation, 27;
    Treatise on Motion of Heart and Blood, 30-33;
    Harvey called crack-brained, 35;
    physician to James I. and Charles I., 35;
    travels on the Continent, 36;
    attendance on Charles I., 36, 37;
    at Edgehill, 37, 38;
    at Oxford, 38;
    studies hatching of eggs, 38;
    appointed Warden of Merton College, 38;
    his museum destroyed, 39;
    leaves Oxford, 39;
    lives with his brothers, 40;
    entrusts Treatise on Generation to Dr. Ent, 41;
    its publication, 42;
    Harvey’s lost medical works, 43;
    benefactions to College of Physicians, 44-47;
    declines Presidency, 45;
    infirmity in old age, 46;
    death and burial, 46;
    will, 46, 47;
    personal character, 47;
    personal appearance, 47, 48;
    lofty intellectual position, 49;
    habits, 49, 50;
    Latinity, 50;
    memorials in College of Physicians, 50;
    William Hunter on, 126;
    records of, in St. Bartholomew’s Hospital, ii. 169.

  Harvey’s brothers, i. 26, 40, 46, 50.

  Harwood, Dr., on William Hunter’s library, i. 129.

  Hawkins, Cæsar, ii. 110.

  Hazelwood School, ii. 261.

  Healing, Caius’ Method of, i. 22.

  Helmholtz, ii. 260.

  Henry VII., i. 1, 2, 4.

  Henry VIII., i. 4, 7, 10, 14.

  Herbert, Sidney, ii. 298.

  Hewson, William, i. 84, 126, 138.

  Hill, Gardiner, and Lunacy, ii. 220, 221.

  HINTON, JAMES (1822-1875);
    early history, ii. 278, 279;
    studies at St. Bartholomew’s Hospital, 280;
    foreign voyages, 280;
    residence in Jamaica, 280;
    intercourse with Toynbee, 281;
    early writings, 281;
    aural practice, 282;
    charm of conversation, 283;
    later publications, 284;
    death, 284.

  Hinton, J. H., ii. 278.

  Hippocrates, the British, i. 52-70.

  Hobbes of Malmesbury, i. 47.

  Hodgson, Joseph, ii. 261.

  Holland, Lord and Lady, i. 294, ii. 65.

  HOLLAND, Sir HENRY (1788-1873), ii. 15;
    early life, 62;
    at Glasgow University, 63;
    draws up Report on Agriculture of Cheshire, 63;
    at Edinburgh, 64;
    in society, 64;
    travels, 64, 65, 68, 69;
    becomes medical attendant to Princess Caroline, 65;
    success and moderation, 66;
    his great energy, 67;
    marriages, 67;
    physician to Queen Victoria, 67, 68;
    death, 68;
    writings, 69;
    Recollections of Past Life, 70.

  Home, Sir Everard, i. 141, 143, 148, 152, 154, 158-161, 178, 290,
        291.

  Houstoun, R., ii. 109.

  Humane Society, i. 147, 284.

  Hume, David, i. 91, 102.

  Hunterian Museums. See Museums.

  Hunterian Oration, i. 309.

  HUNTER, JOHN (1728-1793), i. 123, 124, 127, 131;
    birth and early years, 133;
    visit to Glasgow, 133;
    goes to London and assists his brother, 134;
    his hospital studies, 134;
    short residence at Oxford, 135;
    shares his brother’s lectures, 135;
    his style of lecturing, 136;
    early discoveries, 136;
    dissection of animals, 137;
    becomes staff-surgeon in army, and goes to Belleisle and Portugal,
        137;
    returns home and practises in Golden Square, 138;
    want of tact, 138;
    his brusqueness, 139;
    builds a house at Earl’s Court, and keeps a private menagerie,
        139;
    his encounter with leopards, 139;
    ruptures his _tendo Achillis_, and studies mode of cure, 140;
    elected Fellow of Royal Society, and surgeon to St. George’s
        Hospital, 140;
    takes a house in Jermyn Street, and receives Jenner as pupil, 141;
    marries Miss Home, 141;
    his dislike of fashionable parties, 141;
    writes on the Teeth, and on digestion of stomach after death, 142;
    his principal contributions to the Royal Society, 142, 143;
    his indefatigable industry, 143;
    punctuality and order, 144;
    blunt hospitality, 144;
    employs an artist named Bell, 144, 145;
    lectures on surgery, 145;
    after-dinner habits, 146, 147;
    appointed surgeon to the King, 147;
    Croonian lectures, 148;
    suffers from angina pectoris, 148;
    visit to Bath, 148;
    emotion at his brother’s death, 149;
    his eagerness for specimens, 150;
    obtains skeleton of O’Brien, the Irish giant, 150;
    evidence on murder of Sir T. Boughton, 150;
    Justice Buller’s strictures, 151;
    builds museum in Leicester Square, 151;
    renewed illness, 152;
    portrait by Sir Joshua Reynolds, 153;
    ties femoral artery, 153;
    experiments on deer’s antlers, 153;
    appointed surgeon-general to the army, 154;
    Copley medal awarded, 154;
    Home assists him, 154;
    Hunter writes treatise on Blood, Inflammation, &c., 155;
    dispute with hospital governors and surgeons, 155-157;
    aid to young students, 155;
    discussion at board meeting, and sudden death, 157;
    personal appearance, 158;
    national vote for his museum, 158;
    declined by Physicians, accepted by Surgeons, 158;
    Home and Hunter’s papers, 159;
    Home burns them, 160;
    Hunter the Cerberus of the Royal Society, 161;
    his generosity, 162;
    his income, 162;
    his sense of his own importance, 162;
    religious views, 162;
    removal of remains to Westminster Abbey, 163;
    views on life, 163, 164;
    Dr. Moxon on, 165;
    Sir James Paget on, 166-168;
    Abernethy on, 168;
    Clift on, 168;
    and Edward Jenner, 170, 171, 176;
    and Cline, 203;
    and Astley Cooper, 204, 205;
    and Abernethy, 228, 241;
    and Baillie, ii. 53;
    and ovariotomy, 106.

  HUNTER, WILLIAM (1718-1783), i. 84;
    becomes Cullen’s pupil, 89;
    subsequent friendship with Cullen, 91, 94, 120, 122;
    studies at Edinburgh, 120;
    goes to London, 120;
    studies at St. George’s Hospital, 121;
    lectures on anatomy, 121;
    lack of means, 122;
    enters on obstetric practice, 122;
    visits home, 122;
    Medical Commentaries and other writings, 123;
    disputes as to originality, 123, 127;
    is assisted by John Hunter, 124;
    excellence as a teacher, 124;
    on anatomical controversy, 125;
    on Harvey, 126;
    called in to the Queen, 126;
    chosen professor to the Royal Academy, 127;
    Hunter and the Royal Society, 127, 128;
    Hunterian Museum (now at Glasgow), 128;
    founds anatomical school in Great Windmill Street, 129;
    cost and extent of his collection, 129, 130;
    leaves it to Baillie, with reversion to Glasgow University, 130;
    intends to retire, 130;
    dies, 131;
    portraits of Hunter, 131;
    personal habits and manners, 132;
    bequeaths estate to Baillie, 132;
    and John Hunter, 134;
    and Baillie, ii. 53;
    and ovariotomy, 106.

  Hypochondria, Description of, i. 65.


  India and Jenner, i. 183, 197.

  Infirmary at Edinburgh, i. 78, ii. 26-28, 36-39, 45, 49, 73.

  Jackson, C., ii. 98.

  James I., i. 24, 35.

  Jefferson, President, i. 182.

  Jeffrey, Francis, i. 257, 258, 262.

  JENNER, EDWARD (1749-1823), i. 141, 148;
    apprenticeship, 169;
    inoculation for small-pox, 170;
    becomes John Hunter’s pupil, 170;
    their mutual influence, 171;
    Jenner’s sympathetic qualities, 172;
    suggestion about earthworms, 172;
    his personal appearance, 173;
    wit, poetry, and accomplishments, 174;
    convivial societies, 174, 175;
    studies cow-pox, 176-180;
    publishes discovery of vaccination, 179;
    refuses London practice, 180;
    Jenner and Dr. Woodville, 181;
    discovery made known on Continent, 181;
    in United States, 182;
    in the East, 183;
    Jenner’s patriotic offer, 183;
    publishes brief narrative, 184-186;
    vaccination by non-professionals, 186;
    vaccination attacked, 187;
    gratuitous vaccination, 189;
    public vaccine Board, 190;
    a temple to Jenner, 191;
    the Empress of Russia and Jenner, 191;
    Parliamentary grant, 192;
    Royal Jennerian Institution, 193;
    Treasury delays, 193;
    testimony of Canadian Indians, 194;
    Napoleon and Jenner, 194;
    National Vaccine Establishment, 195;
    Jenner’s inward life, 196;
    second Parliamentary grant, 196, 197;
    gratitude of Europeans in India, 197;
    bereavements, 197;
    death from small-pox after vaccination, 198;
    Jenner’s account, 198;
    presentation to the Czar, 199;
    death of Mrs. Jenner, 199;
    death, 200;
    Dr. Baron on, 200, 201.

  Jennerian Society, Royal, i. 190, 193.

  JENNER, Sir WILLIAM (_b._ 1815);
    studies and early successes, ii. 118;
    papers on Typhoid and Typhus Fevers, 119, 123;
    later appointments and writings, 124, 125;
    on Parkes, 296, 301.

  Jenner, Stephen, i. 169.


  Kaye. See Caius.

  Keate, i. 155.

  Keith, T., ii. 102.

  Key. See Caius.

  King’s College, London, ii. 74, 76, 77, 147, 149, 150, 262-264, 304.

  Knox, Robert, ii. 72, 73.


  Laennec, ii. 5, 181.

  _Lancet, The_, i. 267, 275, 293, 298, 307, 309, 310, ii. 97, 133, 134,
        142, 214, 243, 244, 295.

  Latimer, i. 7.

  LAWRENCE, Sir WILLIAM (1783-1867),
    and Brodie, i. 289;
    education, 303;
    apprenticed
    to Abernethy, 303;
    appointments at St. Bartholomew’s, 304;
    early works, 304;
    professor at College of Surgeons, 305;
    criticism of Abernethy, 305;
    lectures on Man, and controversy thereon, 305-307;
    Lawrence yields to the storm, 307;
    establishes Aldersgate Medical School, 307;
    ophthalmic works, 308;
    relations with College of Surgeons, 308;
    delivers Hunterian oration, 309;
    character of, 310;
    death, 311.

  Lenten preacher at Rome, a, i. 115-117.

  Lifeboat Institution, National, and Marshall Hall, i. 284.

  Lilye, i. 12.

  LINACRE, THOMAS (1460-1524), birth, i. 1;
    descent, 2;
    school-days, 2;
    elected fellow of All Souls’, 2;
    takes pupils, 2;
    travels in Italy, 2;
    graduates M.D. at Oxford, 3;
    translates the “Sphere” of Proclus, 3;
    teaches Erasmus Greek, 3;
    becomes Prince Arthur’s tutor, 3;
    appointed physician to Henry VIII, 4;
    studies theology, 4;
    gains preferments, 5;
    advises Erasmus, 5;
    lectures at Oxford, 6;
    receives a flattering address, 6;
    translates Aristotle and Galen, 7, 8;
    writes on grammar and language, 8;
    founds College of Physicians, 8-10;
    benefactions to it, 10;
    founds lectureships at Oxford and Cambridge, 10-12;
    his practical skill, 12;
    his personal character, 12;
    death, 13;
    buried in St. Paul’s, 13;
    memorial erected by Caius, 13;
    will, 13.

  Lister, Joseph Jackson, F.R.S., ii. 135-137.

  LISTER, Sir JOSEPH (_b_. 1828), ii. 46, 47, 114;
    studies, 137;
    physiological researches, 137;
    professorship at Glasgow, 138;
    unhealthy wards, 138-140;
    carbolic acid and germs, 141;
    the antiseptic system, 141-147;
    diminution of pyæmia, 143, 146;
    experiment on a calf, 143, 144;
    antiseptic gauze, 145;
    carbolic spray, 146;
    corrosive sublimate, 146;
    distinctions conferred upon, 147.

  Liston, Rev. Harry, ii. 24.

  LISTON, ROBERT (1794-1847), education and early years, ii. 24;
    medical study in Edinburgh, 25;
    in London, 25;
    assists Barclay, 25;
    lectures on anatomy and surgery, 26;
    dissensions at the Royal Infirmary, 26-28;
    removes to London, 28;
    works on surgery, 28;
    as an operator, 29, 30;
    his great strength, 30, 31;
    his decision, 31;
    and the College of Surgeons, 32;
    the _Times_ on, 32, 33;
    and Syme, 33, 34, 35-37, 39-41;
    death, 34;
    and Sir J. Simpson, 85;
    and chloroform, 98.

  Lizars, Alexander, ii. 49.

  Lizars, John, ii. 39, 48-50, 74, 109.

  Locke, John, i. 62, 63, 70.

  Lombard, Dr. H. C., ii. 119.

  London Hospital, ii. 250-252.

  London University, i. 257, ii. 163, 176, 301.

  Long, St. John, i. 296.

  Lonsdale, Dr., on Dr. Addison, ii. 3, 12, 13.

  Lorenzo de Medici, i. 2.

  Louis, i. 283, ii. 120.

  Lumleian lectures, i. 27, 35, 44.

  Lunacy, ii. 217-235.

  Lymphatics, i. 84.


  Macilwain on Abernethy, i. 231-233.

  M’Dowell, Ephraim, ii. 107-109.

  M’Kendrick, Dr., on Hughes Bennett, ii. 215, 216.

  MACKENZIE, MORELL (_b._ 1837), on specialism, ii. 240;
    early life, 249, 250;
    medical study, 250, 251;
    Continental studies, 251;
    acquaintance with Czermak, 251;
    appointments at London Hospital, 251, 252;
    work with laryngoscope, 251-254;
    becomes a specialist in diseases of the throat, 252;
    his various works, 253;
    extension of specialism, 253, 254.

  Mackenzie, Stephen, ii. 249, 250, 268.

  Mackenzie’s Travels in Iceland, ii. 15, 64.

  Malpighi, i. 30, note.

  Malthus, i. 61.

  Manchester, Bishop of, on cremation, ii. 117.

  Manutius, Aldus, i. 2, 3.

  Mapletoft, Dr. J., i. 52, 62.

  Mary, Queen, i. 14.

  Materialism, i. 306.

  MAUDSLEY, HENRY (_b._ 1835);
    studies in London, ii. 232;
    appointed Professor at University College, 233;
    writes on Theory of Vitality and on Physiology and Pathology of
        Mind, 233;
    Gulstonian Lectures on Body and Mind, 234;
    case of Victor Townley, 235;
    on Responsibility in Mental Disease, 235;
    on Pathology of Mind, 235;
    on Body and Will, 237, 238.

  Meckel, i. 83.

  Medical and Chirurgical Society, Royal, i. 213, 268, 295, 297, 299,
        ii. 11, 123, 187.

  Medical Association, British, i. 281, ii. 45, 81, 124, 290.

  Medical Council, ii. 159, 164, 289.

  Medical Lectures, i. 75, 90, 92, 95, 96, 97, 100, 103, 106, ii. 5,
        17, 133, 150, 158, 160, 183, 189.

  Medical Society, Royal, of Edinburgh, i. 213, 265, ii. 2, 88, 209,
        222.

  _Medical Times_, ii. 77, 293, 294, 297.

  Medicine, British, Foundation of, i. 1-24.

  Menagerie, Tower, i. 137, 211.

  Merton College, Oxford, i. 38, 39.

  Middlesex Hospital, i. 250, 259, ii. 56, 131, 149, 256.

  Minto House Hospital, ii. 38, 39.

  MONRO, ALEXANDER (_primus_) (1697-1767);
    birth, i. 75;
    education, 75, 76;
    appointed Professor of Anatomy, 76;
    first lecture, 76;
    large classes, 77;
    difficulty of obtaining subjects, 77;
    building of the infirmary, 78;
    clinical lectures, 79;
    post mortem examinations, 79;
    “Osteology,” 79;
    other works, 79;
    Comparative Anatomy, 80;
    private life, 80;
    dresses wounds after Prestonpans, 81;
    death, 81;
    Professor Struthers on, 81.

  MONRO, ALEXANDER (_secundus_) (1733-1817);
    birth, i. 82;
    lectures for his father, 82;
    Continental travels, 82;
    taught by Meckel, 83;
    becomes professor, 83;
    medical practice, 83;
    discoveries on the lymphatic system, 84;
    other works, 85;
    fondness for the stage, 85;
    and for horticulture, 85;
    economy of time, 86;
    favours vaccination, 86;
    death, 87;
    John Bell and, 108, 109.

  MONRO, ALEXANDER (_tertius_), i. 86.

  Monro, John, i. 75, 76.

  Montagu, Lady Mary, i. 100.

  Montanus, i. 14.

  Monteith, Alex., i. 73, 74.

  More, Hannah, ii. 178.

  More, Sir T., i. 2, 3, 11.

  Morris, Edward, i. 197.

  Morton, W. T. G., ii. 98.

  Moxon, Dr., on John Hunter, i. 165, 166.

  Müller, Johannes, and Marshall Hall, i. 270.

  MURCHISON, CHARLES (1830-1879), ii. 119;
    medical studies, 130, 131;
    work in Calcutta and Burmah, 131;
    returns to London, 131;
    appointments, 131;
    work on Continued Fevers, 131-133;
    other writings, 133;
    his teaching powers, 133;
    character, 134.

  Museums, Hunterian, i. 128-130, 151, 158, 159, 163.


  Napoleon I. and Jenner, i. 194.

  National Vaccine Institution, i. 193, 195.

  Nélaton, ii. 11.

  Nightingale, Miss Florence, ii. 265.


  O’Brien, skeleton of, i. 150.

  Orfila, ii. 285, 286, 291.

  Ottley, D., on John Hunter, i. 146.

  Ovariotomy, ii. 106-114.

  Oxford University, Linacre and, i. 2, 3, 6, 7, 11;
    Harvey and, 38, 39;
    Sydenham at, 52-54;
    John Hunter at, 135;
    and Jenner, 199;
    and Baillie, ii. 52;
    and Halford, 56.

  Padua, Linacre at, i. 2;
    Caius at, 14;
    Harvey at, 26.

  PAGET, Sir JAMES (b. 1814), i. 166-168, ii. 72, 114, 143;
    early studies, 167;
    report on results of use of microscope, 168;
    address to students, 168, 169;
    professorship at College of Surgeons, 169:
    publication of lectures, 170;
    conditions of healthy nutrition, 170, 171;
    lecture on Study of Physiology, 172;
    clinical lectures, 172;
    attention to detail, 173;
    serious illness, 173, 174;
    on Theology and Science, 174;
    on alcohol, 175;
    appointments, 176;
    on the College of Surgeons’ Museum, 176;
    on exceptions to types, 177;
    on Study of Science, 177.

  Palmer, trial of, i. 284, ii. 287, 288, 294.

  Palmerston, Lord, ii. 66.

  PARKES, E. A. (1819-1875);
    Harveian oration, i. 25;
    early influences, ii. 296;
    studies at University College, 296;
    goes to Madras and Moulmein, 297;
    practice in London, 297;
    journalistic work, 297;
    physician to University College Hospital, 297;
    serves in Crimean war, 298;
    appointed professor at Army Medical School, 298;
    Manual of Practical Hygiene, 299;
    Army Medical Reports, 300;
    Sir W. Jenner on, 301;
    death, 302.

  Parry, Dr., and Jenner, i. 197.

  Paterson, Dr., Life of Syme by, ii. 31.

  Pathological Society, ii. 185.

  Pathology, i. 145.

  Pearson, Dr., and vaccination, i. 190, 191.

  Pembroke, Earl of, i. 15.

  Pennock, Dr., of Philadelphia, ii. 120.

  Peruvian bark, i. 59.

  Pettigrew, Dr., on Astley Cooper, i. 216-218;
    on Abernethy, 230.

  Petty, Lord H., and vaccination, i. 196.

  Physical Society of Guy’s, i. 213, ii. 6.

  Physicians (Edinburgh), College of, i. 72-73, 76, ii. 289.

  Physicians (Irish), College of, ii. 158, 206.

  Physicians (London), College of, foundation of, i. 1, 8;
    letters patent, 9;
    new statutes, 10;
    Caius and, 15;
    insignia of, 17;
    dissection, 18;
    Harvey Lumleian lecturer at, 27, 35;
    declines presidency, 45;
    Sydenham and, 61;
    and John Hunter’s Museum, 158;
    E. Jenner and, 195, 199;
    Marshall Hall and, 280;
    Bright and, ii. 21;
    Baillie and, 53, 55;
    Halford and, 56, 58;
    W. Jenner and, 124;
    Murchison and, 133;
    Watson and, 151;
    Williams and, 184, 187;
    Maudsley and, 234, 238;
    Parkes and, 298;
    Guy and, 303.

  Pinel, ii. 218, 219.

  Piozzi, Mrs., on Henry Holland, ii. 64.

  Pitcairne, i. 73.

  Pitt, William, i. 158.

  Plempius of Louvain, i. 44.

  Poisons, ii. 4.

  Politian, i. 2.

  Pott, Percival, i. 134, 228.

  Prayer for the sick, ii. 197.

  Prestonpans, i. 81.

  Priestley, Dr., ii. 95.


  Quacks, i. 16, 17, 58.

  Quain, Jones, ii. 241, 242.

  Queen’s University, Ireland, ii. 158.


  Reflex action, i. 272-277.

  Reid, John, ii. 85.

  Reid, Thomas, i. 99, 107.

  Resurrectionists, i. 208-211.

  Reynolds, Dr. Russell, i. 276, 295.

  Reynolds’, Sir Joshua, portrait of William Hunter, i. 131;
    of John Hunter, 153, 163.

  Richardson, John, i. 257.

  Rinderpest, ii. 129.

  Riolan, John, the younger, i. 33, 36, note.

  Roots, Dr. W., and Astley Cooper, 206.

  Royal Institution, ii. 66, 172.

  Royal Society and William Hunter, i. 127;
    and John Hunter, 140, 142, 143, 147, 148, 149, 154;
    and Astley Cooper, 212, 213;
    and Charles Bell, 253;
    and Marshall Hall, 270, 272, 274, 275;
    and Brodie, 291, 292, 297, 300;
    and Lister, ii. 138, 147;
    and Wilson, 244;
    and Bowman, 262;
    and Toynbee, 273, 275;
    and Parkes, 301.

  Russia, Emperor of, i. 195, 199.

  —— Empress of, i. 191.


  Salm, Count de, and vaccination, i. 191.

  Sandford, Bishop, i. 114.

  Sandys, Bishop, i. 20.

  Scott, Sir Walter, ii. 150.

  Selling, William, fellow of All Souls’, i. 2.

  Servetus, i. 27, 28.

  Shagglyng Lecture, i. 6.

  Sharpe, Samuel, i. 121.

  Shaw, Alexander, i. 249, 257, 258.

  Shaw, John, i. 249, 250, 256.

  Shelburne, Lord, i. 128.

  Short, Dr. T., i. 68.

  Sibbald, Sir R., i. 72, 73, 75.

  Siddons, Mrs., i. 85.

  Simmons, Dr. Foart, on William Hunter, i. 132.

  SIMON, JOHN (_b._ 1816);
    student at King’s College, 304;
    appointed lecturer at St. Thomas’s Hospital, 304;
    medical officer to City of London, 304;
    to Board of Health and Privy Council, 304;
    Reports to Privy Council, 305;
    honours, 306.

  Simpson, Alexander, ii. 84, 86, 89, 104.

  SIMPSON, Sir JAMES Y. (1811-1870);
    birth and early years, ii. 83, 84;
    student life in Edinburgh, 85;
    his father’s death, 86;
    disappointed of a parish surgeoncy, 86;
    becomes assistant to Professor Thomson, 87;
    his first original paper, 88;
    description of, when presiding over Medical Society, 88, 89;
    visits London and the Continent, 89;
    his habits of plain speech, 90;
    candidature for professorship of midwifery, 90, 91;
    his success, 91, 92;
    antiquarian paper on Leprosy, 92;
    success in practice, 92, 93;
    complaints of neglect, 93;
    controversies, 94;
    experiments with sulphuric ether, 98;
    introduces chloroform, 99;
    description of Simpson’s parties, 101;
    introduces acupressure, 102;
    attacks hospital system, 102;
    honours, 103;
    bereavements, 103;
    death, 104.

  Slavery, Marshall Hall on, i. 282.

  Smith, Adam, i. 91.

  Smith, Henry, and Marshall Hall, i. 271.

  Smith, Henry, and Sir W. Fergusson, ii. 79, 80, 82.

  Smith, Sydney, and Holland, ii. 67, 68.

  Specialism, ii. 161, 239, 240.

  Squirrel, Dr., and vaccination, i. 188.

  St. Andrews University, i. 175.

  St. Bartholomew’s Hospital, i. 27, 36, 134, 304, 307, ii. 149,
        167-169, 176, 286.

  St. George’s Hospital, i. 134, 140, 154-158, 290, 291, ii. 25, 53,
        59, 269, 273.

  St. Mary’s Hospital, ii. 131, 257, 275.

  St. Thomas’s Hospital, i. 204, 205, 211, 212, 216, 218, 219, 221,
        222, 279, ii. 105, 133, 291, 304.

  Stethoscope, the, ii. 5, 60.

  Stewart, Dr. A. P., ii. 120.

  Stewart, Dugald, i. 63, 95.

  STOKES, WILLIAM (1804-1878);
    studies in Glasgow and Edinburgh, ii. 188;
    writes on the stethoscope, 188;
    early success, 189;
    work on Diseases of the Chest, 189;
    appointed Professor in Dublin University, 189;
    work on Diseases of the Heart, 190;
    lectures on fever, 191;
    on student’s culture, 191;
    on prevention of disease, 192;
    character by Sir H. Acland, 192;
    early rising and geniality, 193;
    death, 193;
    on Graves, 203, 205.

  Struthers, Professor, on Monro _primus_, i. 81;
    on Monro _secundus_, 83, 87;
    on John Bell, 111.

  Surgeons, College of, Edinburgh, i. 72, 75, 77, 208, ii. 44, 49, 73

  Surgeons, College of, London, i. 220, 221, 240, 250, 256, 294, 297,
        304-311, ii. 32, 79, 81, 115, 167, 169, 176, 246, 249, 271,
        305.

  Surgical Lectures, i. 79, 109, 131, 138, 145, 154, 156, 205, 229,
        246, 247, 291, ii. 25, 28, 36, 37, 48, 49, 79.

  Sutherland, James, i. 72.

  Sweating Sickness, i. 15.

  Sydenham College, i. 279, ii. 242.

  —— Society, New, ii. 187, 189.

  SYDENHAM, THOMAS (1624-1689);
    birth, i. 52;
    at Oxford, 52;
    led to choose medicine by Dr. Coxe, 53;
    escapes when shot at in London, 53;
    returns to Oxford, 54;
    removes to London, 54;
    publishes method of curing fevers, 54;
    his principles, 55;
    philosophic views, 56;
    ideas of disease, 57;
    views on nature’s order, 58;
    on quacks and culpable secrecy, 58;
    on Peruvian bark, 59;
    Dr. J. Brown on the “Method,” 59, 60;
    subsequent editions, 60;
    becomes M.D., 61;
    treatise on gout and dropsy, 61;
    death, 61;
    will, 61;
    medicine learnt by practice, 62;
    his opinion of Locke, 62;
    experimental medicine, 63;
    attention to wishes of patients, 64;
    on hysteria and hypochondria, 65;
    Sydenham’s character of himself, 66;
    his humour, 66, 67;
    kindheartedness, 67;
    calumnies on, 68;
    his Rational Theology, 69;
    his religious feelings, 69, 70.

  Sydenham, William, i. 52.

  SYME, JAMES (1799-1870);
    and Liston, ii. 25-27, 31, 33, 34;
    education and early years, 35;
    discovers waterproofing process, 35;
    assists Liston, 36;
    amputation at the hip-joint, 36;
    studies in Germany, 36;
    Brown Square Medical School, 36;
    surgical lectures, 37;
    starts Minto House Hospital, 38;
    clinical lectures, 38;
    Liston’s jealousy, 39;
    gains professorship of surgery, 39;
    reconciliation with Liston, 40;
    Syme’s controversies, 40;
    writings, 41, 44, 45;
    brief removal to London, 41-43;
    great operations, 44;
    Principles of Surgery, 44;
    address to British Medical Association, 45;
    Battle of the Sites, 45;
    private life, 46;
    on antiseptic method, 46;
    testimonial dinner, 47;
    Professor Lister on, 48;
    and Fergusson, 73, 75, 76.


  TAYLOR, A. SWAINE (1806-1880);
    education, ii. 291;
    medical studies, 291;
    studies chemistry and medical jurisprudence, 291;
    appointed to lecture at Guy’s, 292;
    papers and writings, 292, 293;
    appearance as witness, 294;
    the Palmer trial, 294;
    death, 294.

  Theology, Sydenham’s Rational, i. 69.

  THOMPSON, Sir HENRY (_b._ 1820);
    studies in London and Paris, ii. 195;
    twice wins Jacksonian prize, 195;
    appointments at University College, 195, 196;
    Clinical Lectures, 195;
    Practical Lithotomy and Lithotrity, 195;
    Civiale’s operation, 196;
    attends King of the Belgians, 196;
    controversy on Prayer for the Sick, 197;
    on cremation, 198, 199;
    on use of intoxicants, 200;
    on Food and Feeding, 200;
    artistic tastes, 200.

  Thomson, Prof. A. T., ii. 296, 297.

  Thomson, Prof. John, ii. 87, 90.

  Thornhill, Sir James, i. 61.

  _Times, The_, on Liston, ii. 32, 33.

  Todd, R. B., ii. 262-264.

  Tonstal, i. 11.

  Tower Menagerie and John Hunter, i. 137;
    and Astley Cooper, 211.

  TOYNBEE, JOSEPH (1815-1866);
    education, 273;
    medical study, 273;
    researches on the eye, 273;
    aural practice, 274;
    Asylum for Deaf and Dumb, 274;
    researches and dissections, 275;
    appointment to St. Mary’s Hospital, 275;
    ventilation hobby, 275, 276;
    Hints on Local Museums, 276;
    artificial tympanic membrane, 276;
    melancholy death, 277;
    intercourse with Hinton, 281.

  Travers, Mr., on Astley Cooper, 207.

  Treatment, expectant, i. 59.

  Trousseau, ii. 6, 11;
    on Graves, 206, 207.

  Tuke family and lunacy, ii. 219, 220, 231.

  Turner, J. M. W., ii. 202.

  Typhoid and Typhus Fevers, ii. 119-133.


  University College, London, i. 257, ii. 28, 41-43, 118, 124, 137,
        149, 183, 195, 196, 222, 232, 233, 273, 296-298.


  Vaccination, i. 178-200.

  Vaccine Institution, National, i. 193, 195.

  Vaughan family, the, ii. 55, 56.

  Vaughan, Henry. See Halford, Sir Henry.

  Vesalius, i. 14.

  Victoria, Queen, i. 311, ii. 57, 60, 67, 68, 81, 124, 151, 158, 164,
        176, 188, 196.

  Vitelli, Cornelio, i. 2.

  Vivisection, i. 252, 271-275, 292, ii. 143, 165, 265.


  Wakley, Thomas, ii. 243, 245.

  Walker, Dr., and vaccination, i. 193.

  Wallis, John, ii. 267.

  Warren, Dr. J. C., and anæsthetics, ii. 98.

  Waterhouse, Prof., i. 182.

  Waterloo, Charles Bell at, i. 250.

  WATSON, Sir THOMAS (1792-1882), ii. 128;
    education, 148;
    elected fellow of St. John’s, Cambridge, 149;
    medical studies in Edinburgh and London, 149;
    becomes proctor at Cambridge, 149;
    removes to London, 149;
    appointments, 149, 150;
    and Sir Walter Scott, 150;
    lectures published, 150;
    honours, 151;
    Introductory Lecture, 151-153;
    Dr. West on, 153;
    British Medical Journal on, 154;
    death, 155.

  Webb Street School of Medicine, i. 279.

  Wells, Horace, ii. 97.

  West, Dr. C., on Sir T. Watson, ii. 153.

  Westfaling, Thomas, i. 179.

  WELLS, Sir T. SPENCER (_b._ 1818),
    on Sir W. Fergusson, ii. 72;
    student life in Leeds, Dublin, and London, 105;
    joins Samaritan Hospital, 106;
    experience in Crimean war, 110;
    early experiences in ovariotomy, 111, 112;
    stringent precautions, 113;
    great successes, 113, 114;
    adopts antiseptic system, 114;
    on surgery as salvaging, 115;
    municipal and state questions, 116;
    on cremation, 117.

  Whytt, Andrew, i. 95, 100, 273.

  Wilkes, John, i. 100.

  Wilks, Dr., on Dr. Addison, ii. 8-11;
    on Dr. Bright, 18.

  William IV., i. 224, 259, 295, ii. 57, 60.

  WILLIAMS, CHARLES J. B. (_b._ about 1800);
    early education, ii. 178;
    scientific experiments, 179;
    studies at Edinburgh, 179;
    chemical researches, 180;
    studies in London and Paris, 180;
    work on Stethoscope, 181;
    settles in London, 181;
    early writings, 182;
    sounds of heart, 182;
    Lectures at Kinnerton Street, 183;
    reports to British Association, 183;
    becomes Professor at University College, 183;
    Gulstonian lectures, 184;
    physician to Hospital for Consumption, 185;
    Principles of Medicine, 185;
    first president of Pathological Society, 185;
    work on Cod-Liver Oil, 186, 187;
    presidency of New Sydenham Society, and of Medical and Chirurgical
      Society, 187;
    studies in retirement, 188.

  WILSON, ERASMUS (1809-1884);
    early life, ii. 240, 241;
    studies under Abernethy, and in Paris, 241;
    pupil of Langstaff, 241;
    joins Aldersgate School of Medicine, 241;
    assists Quain at University College, 242;
    establishes Sydenham College, 242;
    writes the Dissector’s Manual and Anatomist’s Vade Mecum, 242;
    acquaintance with Thomas Wakley, and appointment on _The Lancet_,
        243;
    becomes a specialist in skin diseases, 243;
    portraits of diseases of skin, 244;
    Continental studies, 244;
    character in practice, 244, 245;
    the case of flogging at Hounslow, 245;
    various works, 246;
    founds professorship of dermatology, 246;
    and of pathology, 246;
    becomes President of College of Surgeons, 247;
    pays for bringing Cleopatra’s Needle to London, 247;
    his great munificence, 248;
    bequest to College of Surgeons, 249;
    death, 249.

  Wilson, i. 249, 256, 290, 291.

  Windmill Street School, i. 129, 140, 156, 249, 256, 290, 291, ii. 59.

  Wolsey, Cardinal, i. 4, 8.

  Wood, Alexander, i. 108.

  Woodville, Dr., and vaccination, i. 181, 187.


  Yelloly, Dr., on Astley Cooper, i. 214.

  York, Duke of, and Abernethy, i. 234.


  Zoological Society, i. 274.




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List of Books

  _SEASON_]      :Published by        [1885-1886.

JOHN HOGG, 13, Paternoster Row, London, E.C.

In two vols., crown 8vo., cloth, price 21s.


  =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.

  CHAP.

  1. LINACRE, CAIUS, and the Foundation of British Medicine.
  2. WILLIAM HARVEY and the Circulation of the Blood.
  3. THOMAS SYDENHAM, the British Hippocrates.
  4. The MONROS, CULLEN, The GREGORYS, JOHN BELL, and
        the Foundation of the Edinburgh School.
  5. The HUNTERS and the Applications of Anatomy and Physiology to
        Surgery.
  6. EDWARD JENNER and Vaccination.
  7. SIR ASTLEY COOPER and ABERNETHY: the Knife _versus_ Regimen.
  8. SIR CHARLES BELL and the Functions of the Nervous System.
  9. MARSHALL HALL and Reflex Action.
  10. SIR B. BRODIE and SIR WM. LAWRENCE: two Great Practical Surgeons.
  11. ADDISON and BRIGHT, and the Diseases which bear their Names.
  12. LISTON, SYME, LIZARS, and the Newer Surgery.
  13. BAILLIE, HALFORD, CHAMBERS, and HOLLAND:
        Fashionable and Courtly Physicians.
  14. SIR WM. FERGUSSON and Conservative Surgery.
  15. SIR JAMES SIMPSON and Anæsthetics.
  16. SIR SPENCER WELLS and Ovariotomy.
  17. SIR WILLIAM JENNER, BUDD, MURCHISON, and Typhoid Fever.
  18. SIR JOSEPH LISTER and Antiseptic Surgery.
  19. SIR F. WATSON, SIR DOMINIC CORRIGAN, SIR W. GULL,
        and Clinical Medicine.
  20. SIR JAMES PAGET and Surgical Pathology.
  21. DR. WILLIAMS, STOKES, and Diseases of the Chest.
  22. SIR HENRY THOMPSON and Cremation.
  23. GRAVES, HUGHES BENNETT, and Clinical Teaching.
  24. CONOLLY, MAUDSLEY, and Mental Diseases.
  25. EMINENT SPECIALISTS: SIR ERASMUS WILSON and Skin Diseases;
        MORELL MACKENZIE and Throat Diseases; COBBOLD
        and Internal Parasites.
  26. EMINENT SPECIALISTS, _continued_:—SIR WILLIAM
        BOWMAN, BRUDENELL CARTER, and Eye Diseases;
        TOYNBEE, HINTON, and Ear Diseases.
  27. SIR R. CHRISTISON, DR. A. SWAYNE TAYLOR, and Poison Detection.
  28. PARKES, ANSTIE, ED. SMITH, SIMON,
        BUCHANAN, and Public Health.

[Illustration: Bookmaker’s Mark]




CLASSIFIED CONTENTS OF CATALOGUE


Books @ 1s. and 1s. 6d.

        PAGE

  Toothsome Dishes: The New Shilling Cookery Book                       6
  Self-Help for Women: A Guide to Business                              9
  The Band of Mercy Guide to Natural History                           21
  The Dictionary of 1,000 Christian Names                              17


Books @ 2s. 6d.

  Every Cloud has its Silver Lining, and other Proverb Stories. First
  Series                                                                5
  One Thing at a Time, and other Proverb Stories. Second Series         5
  Plodding On; or, The Jog-trot to Fame and Fortune                    17
  Facts and Phases of Animal Life                                      20
  Andersen’s Shoes of Fortune and other Fairy Tales                    22
  Far-famed Tales from the Arabian Nights                              21
  Wonderful Animals: Working, Domestic, and Wild                       20
  Mottoes and Aphorisms from Shakespeare                               23
  Hood’s Guide to English Versification                                23
  Fortunate Men: How they made Money and won Renown                    22


Books @ 3s. 6d.

  The Secret of Success; or, How to get on in the World                10
  Our Redcoats and Bluejackets: War Pictures on Land and Sea           10
  The Parlour Menagerie. Woodcuts by Bewick and others                 11
  Boys and their Ways: A Book for and about Boys                       12
  Plain Living and High Thinking; or, Practical Self-Culture           12
  The Glass of Fashion. Etiquette and Home Culture                     13
  Girls and their Ways: A Book for and about Girls                     13
  The Pilgrim’s Progress. Life by Southey, and Harvey’s Illustrations  14
  The Church Seasons, Historically and Poetically Illustrated          14
  Exemplary Women: Feminine Virtues and Achievements                   15
  The Ocean Wave: Voyages, Seamen, Discoveries, Shipwrecks, and
  Mutinies                                                             16
  The Life and Adventures of Robinson Crusoe                           16
  Our Homemade Stories         }                   {                   18
  Stories of Young Adventurers }                   {                   18
  Evenings away from Home      } By ASCOTT R. HOPE {                   19
  A Book of Boyhoods           }                   {                   18
  Stories out of School-time   }                   {                   19
  Young Days of Authors        }                   {                    3
  The Adventures of Maurice Drummore (Royal Marines) by Land and Sea   15
  Your Luck’s in your Hand; or, The Science of Modern Palmistry         8
  Dainty Dishes. By Lady Harriet St. Clair                              6
  Landmarks of English Literature                                       7
  Great Movements, and Those who Achieved Them                          7
  Blakely’s Popular Technical Dictionary of Commercial and General
  Information                                                           3


Books @ 4s. 6d., 6s., 6s. 6d., and 7s. 6d.

  The Birthday-Book of Art and Artists                                  9
  “In Perils Oft.” Romantic Biographies Illustrative of the Adventurous
  Life                                                                  3
  Woman’s Work and Worth in Girlhood, Maidenhood, and Wifehood          7
  The Manuale Clericorum. Abridged from “The Directorium Anglicanum”   23


Edition de Luxe; price 7s. 6d.

  Robinson Crusoe. Stothard’s Illustrations, engraved by Heath          4


Books @ 21s.

  Eminent Doctors: Their Lives and their Work. Two Vols.                1
  The Directorium Anglicanum                                           23


Libraries for Young Readers.

  Ascott Hope’s Anchor Library of Fact and Fiction. Six Illustrated
  Volumes, in Elegant Illustrated Metal Case. Price 21s.               24

  The Boys’ and Girls’ Treasury of Natural History, Fairy Tales,
  Biography, and Proverb Stories. Seven Illustrated Volumes, in Elegant
  Illustrated Metal Case. Price 17s. 6d.                               24




_PUBLISHING SEASON_, 1885-6.


MR. ASCOTT R. HOPE’S NEW BOOK.

WITH EIGHT ILLUSTRATIONS ON TONED PAPER.

Small crown 8vo., 384 pp., cloth, price 3s. 6d.; gilt edges, 4s.

  =Young Days of Authors.= By ASCOTT R. HOPE, Author of “Stories of
  Young Adventurers,” “Stories out of School-time,” etc.


CONTENTS:

  1. BOYS IN ARMS.
  2. A POET’S BOYHOOD.
  3. A MIDSHIPMAN OF THE OLD SCHOOL.
  4. A YOUTH OF FAME AND FORTUNE.
  5. A WORKING BOY.
  6. A SCOTCH LASSIE IN AMERICA.
  7. A STORY-TELLER’S OWN STORY.
  8. A RUSSIAN CADET.


_Dedicated by permission to Sir RICHARD TEMPLE, Bart., G.C.S.I.,
etc., late Governor of Bombay._

WITH SIXTEEN ILLUSTRATIONS ON TONED PAPER.

Crown 8vo., 544 pp., cloth, bevelled boards, price 6s.; gilt edges,
6s. 6d.

  “=In Perils Oft.=” =Romantic Biographies= Illustrative of the
  Adventurous Life. By W. H. DAVENPORT ADAMS, Author of “Plain Living
  and High Thinking,” “Secret of Success,” “Woman’s Work and Worth,”
  etc.

“We are a wonderful people; it was never our Government which
made us a great nation.... England was made by Adventurers, not
by its Government; and I believe it will only hold its place by
Adventurers.”—_Journals of Major-General C. G. Gordon, C.B., at
Khartoum._

“Adventures are to the Adventurous.”


CONTENTS:

  CHAP.

   1. THE HERO OF ST. JEAN D’ACRE.
   2. THE LAST OF THE SEA-KINGS.
   3. A HUNGARIAN DERVISH.
   4. THE MODERN WANDERING JEW.
   5. ARCTIC ADVENTURE.
   6. DISCOVERY OF THE ALBERT NYANZA.
   7. THE RAJA OF SARAWAK.
   8. ADVENTURES IN THE ARABIAN DESERT.
   9. THE WONDERFUL RIDE TO MERV.
  10. THE ENGLISH “SHEIKH.”
  11. THE HERO OF KHARTOUM.


Second edition, small crown 8vo., 384 pp., cloth, price 3s. 6d.; gilt
edges, 4s.

  =A Popular Technical Dictionary of= Commercial and General
  Information. By EDWARD T. BLAKELY, F.S.A. (of the Board of Trade).

“To young people destined for business, this Manual supplies a
variety of Technical Information such as no other book in the
language offers so compactly.”—_Extract from the Author’s Preface._


EDITION DE LUXE.

WITH STOTHARD’S ILLUSTRATIONS, ENGRAVED BY HEATH.

_Richly bound in blue, black, and gold, gilt edges._

In one volume, demy 8vo., cloth, price 7s. 6d.; half morocco extra,
12s. 6d.

  =The Life and Adventures of Robinson= Crusoe, with a Sketch of
  Defoe, by HENRY J. NICOLL. (Printed from a new font of old-faced
  type.)

  NOTE.—This is a complete, unabridged edition of Defoe’s
  masterpiece, with all the 22 beautiful Illustrations from the
  Drawings by THOMAS STOTHARD, R.A., engraved by CHARLES HEATH.
  These Illustrations are now printed from the Original Copper
  Plates, which were produced at great cost, and are still in perfect
  condition, having been steel-faced to preserve them. Copies of
  the Original Edition with these same plates, published by Messrs.
  Cadell and Davis in 1820, now fetch a high price.


“Mr. Hogg is to be thanked for re-issuing the ‘Life and Adventures
of Robinson Crusoe,’ with Stothard’s twenty-two designs engraved
on copper by Charles Heath. Their charm is irresistible, and as
book prints they rank among the classics of English art. They are
delightful works. The text before us is complete, and well printed in
a clear type. This edition is, therefore, excellent.”—_Athenæum._

“It was a happy idea of Mr. Hogg to secure the original
copper-plates, and to present his handsome edition of Defoe’s
masterpiece with the most appropriate illustrations that it ever
received. The whole of the twenty-two engravings are given, and we
can congratulate the admirers of the immortal tale, which has been
more truthfully and tenderly illustrated by Stothard than by any
other artist.”—_Queen._

“This is truly an _edition de luxe_ of Defoe’s masterpiece. It is
beautifully printed and enriched with twenty-two full-page engravings
from the drawings of Thomas Stothard, R.A., and altogether is a book
to please the eye and delight the heart of all who have ‘a weak side’
to our sterling old British classics.”—_North British Daily Mail._

“An admirable edition of the immortal ‘Robinson Crusoe,’ adorned with
engravings from Stothard’s celebrated designs, forming a sumptuous
present.”—_Truth._

“The plates come out in this edition with the sharpness of their
earliest days, and are full of force and grace. Those who get this
copy of Defoe’s great work will indeed have a pleasure.”—_Scotsman._

“A book which many would desire to have on their shelves in
common with other English classics. Small editions are numerous
enough, but Mr. John Hogg now supplies us with a handsome library
volume, which, moreover, has the advantage of Stothard’s exquisite
designs engraved by Heath. The volume, a full-size 8vo., finely
printed with wide margins, has a critical introduction by Henry J.
Nicoll.”—_Bookseller._

“An edition printed in fine bold type, and containing reproductions
of Stothard’s well-known illustrations. And, what is more,
it contains not only the ‘Adventures’ but also the ‘Further
Adventures’ of Robinson Crusoe, which are often omitted from popular
editions.”—_St. James’s Gazette._

“This is one of the handsomest editions of Defoe’s immortal work
which we have seen an _edition de luxe_, indeed. It is a trite,
but in this case a perfectly fitting statement, that Mr. Hogg has
spared no expense in the production of what is at once a beautiful
gift-book, and an equally beautiful volume for the drawing-room
table.”—_Manchester Weekly Post._

“_Editions de luxe_ of standard works being in constant demand,
Mr. Hogg has done well to add to the list this handsome edition of
Defoe’s masterpiece. Stothard’s designs, it need scarcely be said,
are greatly superior to the ordinary run of book engravings, being
admirable alike as illustrations and on account of their intrinsic
merits. Altogether the book may be confidently recommended to those
who desire to possess a library edition of a work which seems
likely to maintain its proud pre-eminence, and it would not be easy
to find a work better adapted in all respects for presentation
purposes.”—_Aberdeen Free Press._

“Everybody may not be aware of this latest and most beautiful edition
of the adventures of the old York mariner. We may say then, without
qualification, that this volume is one of the most elegant that has
come out of the press this season. The sketch of Defoe is very well
done.”—_Yorkshire Gazette._

“Few of the many reprints of works of acknowledged excellence that
have been recently published will surpass the one now under notice in
intrinsic worth.”—_Glasgow Herald._




_PROVERB STORIES FOR BOYS AND GIRLS._


I.

Small crown 8vo., cloth, 256 pp., with 36 Illustrations, price 2s.
6d.; gilt edges, 3s.

  =Every Cloud has its Silver Lining=, and other Proverb Stories
  for Boys and Girls. First Series. By MRS. J. H. RIDDELL, MRS.
  M. DOUGLAS, MARIA J. GREER, and other Authors. With Thirty-six
  Illustrations by A. W. COOPER, A. CHASEMORE, ADELAIDE CLAXTON, and
  other Artists.


CONTENTS.

  STOCKTON MANOR; OR, EVERY CLOUD HAS ITS SILVER LINING. BY CONSTANCE
  BURNET.

  THE CURATE OF LOWOOD; OR, EVERY MAN HAS HIS GOLDEN CHANCE. BY MRS.
  J. H. RIDDELL.

  THE ORPHANS; OR, NO HAND NEED BE EMPTY WHILE THERE IS SEED TO BE
  SOWN. BY CONWAY EDLESTON.

  LADY MADALENA; OR, NEVER MAKE A MOUNTAIN OF A MOLE-HILL. BY THE
  AUTHOR OF “MY MOTHER’S DIAMONDS.”

  JULIET PERCY; OR, HANDSOME IS AS HANDSOME DOES. BY MARY COMPTON.

  THE ROMANCE OF THE TERRACE; OR, NEVER WADE IN UNKNOWN WATERS. BY
  MARIA J. GREER.

  ROVER AND HIS FRIENDS; OR, A FRIEND IN NEED IS A FRIEND INDEED.
  FROM THE FRENCH OF MADAME COLOMB.

  THE YOUNG ENGINEER; OR, SOMETIMES WORDS WOUND MORE THAN SWORDS. BY
  MRS. M. DOUGLAS.


II.

Small crown 8vo., cloth, 256 pp., with 33 Illustrations, price 2s.
6d.; gilt edges, 3s.

  =One Thing at a Time, and other= Proverb Stories for Boys and
  Girls. Second Series. By ETHEL COXON, MRS. DOUGLAS, MADAME COLOMB,
  and other Authors. With Thirty-three Illustrations by A. CHANTREY
  CORBOULD, A. W. COOPER, HARRIET BENNETT, and other Artists.


CONTENTS.

  A RULE OF CONDUCT; OR, ONE THING AT A TIME. BY MADAME COLOMB.

  A BRAVE BOY’S TRIALS; OR, SAY WELL IS A GOOD WORD, BUT DO WELL IS A
  BETTER. BY ETHEL COXON.

  COUSIN FLORENCE; OR, BEAUTY IS BUT SKIN DEEP. BY CONWAY EDLESTON.

  THE QUIET DAUGHTER; OR, WHEN THE SUN HAS SET THE LITTLE STARS MAY
  SHINE. BY MRS. M. DOUGLAS.

  THE LITTLE MODEL; OR, ’TIS A LONG DAY WHICH HAS NO NIGHT. FROM THE
  FRENCH.

  A DAZZLING ACQUAINTANCE; OR, FAIR WORDS BUTTER NO PARSNIPS. BY MRS.
  M. DOUGLAS.

  THE BEST SUIT; OR, ONE DOES NOT DO WHAT ONE OUGHT UNLESS ONE DOES
  WHAT ONE CAN. BY WALTER CLINTON.


THE NEW SHILLING COOKERY-BOOK.

In crown 8vo., 160 pp., price 1s.

  =Toothsome Dishes: Fish, Flesh, and= Fowl; Soups, Sauces, and
  Sweets. With Household Hints and other Useful Information. Edited
  by CARRIE DAVENPORT.

  INTRODUCTION:—1. Foods in Season; 2. Tables of Weights and
  Measures; 3. A Ready Reckoner to check Bills; 4. Cooking Requisites
  and Utensils; 5. Condiments, etc., to keep in Stock.

  SOUPS:—How to make Soups. Recipes.

  SAUCES:—How to make Good Sauces. Recipes.

  FISH:—How to choose Fish. Recipes.

  MEAT:—1. How Meat is cut up; 2. Joints (how used); 3. How to choose
  Meat; 4. Modes of Cooking (how to roast, boil, broil, stew, etc.);
  5. Recipes.

  POULTRY AND GAME:—How to choose. Recipes.

  ECONOMICAL COOKERY:—How to utilize Cold Meat, Scraps, etc.

  VEGETABLES:—Including Salads, Pickling, etc. Recipes.

  SWEETS, ETC.:—Pastry, Puddings, Cakes, Biscuits, Scones, etc.
  Recipes.

  PICKLES, PRESERVES, FORCEMEAT, ETC.:—Recipes.

  EGGS, CHEESE, ETC.:—How to choose and preserve. Recipes.

  COOKERY FOR INVALIDS:—Recipes for the Sick and Convalescent.

  MISCELLANEA:—Various Odds and Ends, including Tea, Coffee, etc.

  APPENDIX:—Various Household Hints.


“=A most attractive general cookery-book.=”—_Examiner._

_Tenth edition, small crown 8vo., 392 pp., cloth, price 3s. 6d._

  =Dainty Dishes. Receipts collected by= LADY HARRIET ST. CLAIR (late
  Countess Münster).

“In spite of the number of cookery-books in existence, Lady Harriet
St. Clair’s volume is well worth buying, especially by that class of
persons who, though their incomes are small, enjoy out-of-the way and
_recherché_ delicacies.”—_Times._

“It is true to its title, but shows that ‘dishes’ may be ‘dainty’
without being costly or elaborate, with nothing but wholesome
ingredients to begin with, and delicate management in the
cooking.”—_Examiner._

“It is a capital cookery-book. All the recipes are clear and well
conveyed, and they will enable anyone who chooses to follow them to
produce capital cookery.”—_Scotsman._

“The contents of the volume are varied, much attention being
bestowed on Scotch dishes, and it is something to say in this age
of many cookery-books, that the recipes given are not fanciful, but
practical. They can really be cooked, a recommendation that cannot be
given to many of our cookery-books.”—_Glasgow Herald._

“A design so excellent, and an accomplishment so complete, may well
recommend this volume to the consideration of the ladies of this
kingdom. If economy can be combined with an agreeable and nutritious
diet, by all means let the fact be well known.”—_British Mail._

“Those house-wives who wish to improve in the now fashionable art of
cookery, will find a storehouse of plain, practical teaching in this
book.”—_Literary Churchman._

“The late Countess Münster has not only laid English and French
kitchens under contribution, but takes us to Italy, Germany, Russia,
and even to Poland, in search of any dish that may be toothsome,
wholesome, and made easily and cheaply.”—_Bookseller._

“A book of gastronomic delicacies enough to make the mouth
water.”—_Surrey Comet._

“Here is a cookery-book unique in character, and well worth
studying.”—_Educational Times._


_Second and Cheap Edition, with Twelve Portraits._

Small crown 8vo., 472 pp., cloth, price 3s. 6d.; gilt edges, 4s.

Landmarks of English Literature.

By HENRY J. NICOLL, Author of “Great Movements,” etc.


CONTENTS:

  INTRODUCTION: Explains the Plan of the Book, and gives some Hints
  on the Study of Literature.

  THE DAWN OF ENGLISH LITERATURE.

  THE ELIZABETHAN ERA.

  THE SUCCESSORS OF THE ELIZABETHANS.

  THE LITERATURE OF THE RESTORATION.

  THE WITS OF QUEEN ANNE’S TIME.

  OUR FIRST GREAT NOVELISTS.

  JOHNSON AND HIS CONTEMPORARIES.

  THE NEW ERA IN POETRY.

  SIR WALTER SCOTT AND THE PROSE LITERATURE OF THE EARLY PART OF THE
  NINETEENTH CENTURY.

  OUR OWN TIMES.

  PERIODICALS, REVIEWS, AND ENCYCLOPÆDIAS.

“We can warmly commend this excellent manual. Mr. Nicoll is a fair
and sensible critic himself, and knows how to use with skill and
judgment the opinions of other critics. His book has many competitors
to contend with, but will be found to hold its own with the best of
them.”—_St. James’s Gazette._

“Mr. Nicoll’s facts are commendably accurate, and his style is
perfectly devoid of pretentiousness, tawdriness, and mannerism, for
which relief in the present day an author always deserves much thanks
from his critics.”—_Saturday Review._

“Mr. Nicoll has performed his task with great tact, much literary
skill, and with great critical insight. No better book could be put
into the hands of one who wishes to know something of our great
writers, but who has not time to read their works himself; and no
better guide to the man of leisure who desires to know the best
works of our best writers and to study these in a thorough manner.
Mr. Nicoll’s literary estimates are judicious, wise, and just in an
eminent degree.”—_Edinburgh Daily Review._

“Mr. Nicoll’s well-arranged volume will be of service to the student
and interesting to the general reader. Biography and history are
combined with criticism, so that the men are seen as well as their
works.... The copious and careful table of chronology gives a
distinct value to the book as a work of reference. The volume is
without pretension, and deserves praise for simplicity of purpose, as
well as for careful workmanship.”—_Spectator._


_Second and Cheap Edition._

WITH EIGHT PORTRAITS, 464 pp., crown 8vo., cloth, price 3s. 6d.; gilt
edges, 4s.

  =Great Movements and those who= Achieved Them. By HENRY J. NICOLL,
  Author of “Landmarks of English Literature,” etc.

“A useful book.... Such work ... should always find its reward in an
age too busy or too careless to search out for itself the sources of
the great streams of modern civilization.”—_Times._

“An excellent series of biographies.... It has the merit of
bespeaking our sympathies, not as books of this class are rather apt
to do, on the ground of mere success, but rather on the higher plea
of adherence to a lofty standard of duty.”—_Daily News._

“Immense benefit might be done by adopting it as a prize book for
young people in the upper classes of most sorts of schools.”—_School
Board Chronicle._


Crown 8vo., 576 pp., cloth, price 6s. 6d.; gilt edges, 7s.

  =Woman’s Work and Worth in Girlhood,= Maidenhood, and Wifehood.
  With Hints on Self-Culture and Chapters on the Higher Education and
  Employment of Women. By W. H. DAVENPORT ADAMS.

“It is a small thing to say that it is excellent, and it is only
justice to add that this all-important subject is dealt with in a
style at once masterly, erudite, charming.”—_Social Notes._

“As an aid and incitement to self-culture in girls, and pure
and unexceptionable in tone, this book may be very thoroughly
recommended, and deserves a wide circulation.”—_English-woman’s
Review._

“It is a noble record of the work of woman ... and one of the very
best books which can be placed in the hands of a girl.”—_Scholastic
World._


WITH FIVE WOOD-CUTS, ILLUSTRATING “THE HAND OF GOOD FORTUNE,” ETC.

Crown 8vo., 304 pp., cloth, price 3s. 6d.

  =Your Luck’s in Your Hand; or, The= Science of Modern Palmistry,
  chiefly according to the Systems of D’Arpentigny and Desbarrolles,
  with some Account of the Gipsies. By A. R. CRAIG, M.A., Author of
  “The Philosophy of Training,” etc. Third Edition.

  CHAP.

   1. PALMISTRY AS A SCIENCE.
   2. ANCIENT PALMISTRY.
   3. THE MODERN SCIENCE AND ITS HIGH PRIEST.
   4. SIGNS ATTACHED TO THE PALM OF THE HAND.
   5. THE THUMB.
   6. HARD AND SOFT HANDS.
   7. THE HAND IN CHILDREN.
   8. SPATULED HAND.
   9. THE ENGLISH HAND.
  10. THE NORTH AMERICAN HAND.
  11. THE ARTIST HAND.
  12. THE USEFUL HAND.
  13. CHINESE HANDS.
  14. THE HAND OF THE PHILOSOPHER.
  15. THE HAND PSYCHICAL.
  16. MIXED HANDS.
  17. THE FEMALE HAND.
  18. M. DESBARROLLES AND THE ADVANCED SCHOOL.
  19. PALMISTRY IN RELATION TO THE FUTURE.
  20. THE THREE WORLDS OF CHIROMANCY.
  21. THE MOUNTS AND LINES.
  22. THE LINE OF THE HEAD.
  23. THE LINE OF LIFE—OF SATURN—OF THE LIVER—OF VENUS.
  24. THE LINE OF THE SUN.
  25. THE RASCETTE.
  26. THE SEVEN CAPITAL SINS.
  27. POWER OF INTERPRETATION.
  28. THE ASTRAL FLUID.
  29. THE CHILDREN OF THE RULING PLANETS: THEIR CHARACTERS.
  30. READINGS OF THE HANDS OF CELEBRATED MEN AND WOMEN.
  31. M. D’ARPENTIGNY AND THE GIPSIES—MR. BORROW’S RESEARCHES.
  32. GIPSY CHIROMANTS.
  33. THE HAND AS AFFECTED BY MARRIAGE.
  34. CONCLUSION.

“The glove-makers ought to present the author with a service of gold
plate. He will be a rash man who lets anybody see his bare hands
after this. We are anxious to find a lost pair of gloves before we go
out for a breath of fresh air after such an exhausting study as this
book has furnished us.”—_Sheffield and Rotherham Independent._

“Palmistry, chiromancy, and their kindred studies, may be mystical,
indeed, but never unworthy. There is more in them than the mass
imagine, and to those who care to wade into them. Mr. Craig will
prove himself a capital guide.”—_Manchester Weekly Post._

“The illustrations are curious. Those whose care to study the matter
of hands, fortunate or unfortunate, will find abundant materials
here.”—_Literary World._

“It is certainly a ‘handy book,’ for hands of every class are so
carefully described that all the signs of the palms may be readily
‘got up’ by those who wish to deal in this simplest of the dark
sciences.”—_Publishers’ Circular._

“The work is of surpassing interest.”—_Aberdeen Journal._

“Gives the fullest rules for interpreting the lines and marks on
the hands, fingers, and wrists, as well as the points of character
indicated by their shape. We can imagine this little book, which is
illustrated by five diagrams, being a source of a large amount of
amusement.”—_Bookseller._


  =Manuals of Self-Culture for Young= Men and Women.

  1. =The Secret of Success.= See page 10.
  2. =Plain Living and High Thinking.= See page 12.
  3. =Woman’s Work and Worth.= See page 7.
  4. =Hood’s Guide to English Versification.= See page 23.
  5. =Landmarks of English Literature.= See page 7.


_Dedicated, by express permission, to Sir FREDERICK LEIGHTON, P.R.A._

PRINTED IN BROWN INK, WITH TWELVE FLORAL ILLUSTRATIONS, AND THE
BINDING DESIGNED BY “LUKE LIMNER,” F.S.A.

Imperial 16mo., cloth, bevelled boards, interleaved, 432 pages, price
4s. 6d. gilt edges.

  =The Birthday-Book of Art and Artists.= Compiled and Edited by
  ESTELLE DAVENPORT ADAMS, Editor of “Rose Leaves,” “Flower and
  Leaf,” etc.

  “Mrs. Adams’ pleasant _Birthday Book_ you eagerly will
  con.”—_Punch._

  “Birthday books we have seen in abundance, but this bears away the
  palm.”—_Guernsey Mail._

  “Estelle Davenport Adams has bestowed infinite trouble on her
  ‘Birthday Book of Art and Artists,’ which is quite an artistic
  encyclopædia on a small scale.”—_Graphic._

  “Few of the infinite variety of birthday books have been planned
  more ingeniously, or to more useful purpose, than this, which ought
  to secure a large share of the popularity lavished on these pretty
  manuals.”—_Glasgow Herald._

  “A handy little book for those persons who take note of birthdays,
  either for the giving or taking of presents.”—_Athenæum._

  “Altogether it is a birthday book to be coveted.”—_Scotsman._

  “The book may really be very useful, and concludes with an
  excellent index.”—_Saturday Review._

  “Mrs. Davenport Adams has combined in miniature something of a
  catalogue of art, a biographical dictionary of artists, and a
  dictionary of artistic criticism, and has thereby done a thing
  which may be of some service.”—_World._

  “Quite a dictionary of dates as to the birthdays of eminent
  artists, for, besides those whose names are allotted to the days of
  the year, there is a supplementary list. The quotations are well
  made. The book itself is a work of art.”—_Sword and Trowel._


120 pp., small crown 8vo., boards, price 1s.; or bound in cloth, 1s.
6d.

  =Self-Help for Women: A Guide to= Business. With Practical
  Directions for Establishing and Conducting Remunerative Trades and
  Business Occupations suitable for Women and Girls. By A WOMAN OF
  BUSINESS.

  1. CELEBRATED WOMEN OF BUSINESS.
  2. SELECTING A BUSINESS.
  3. CONDUCTING A BUSINESS.
  4. THE BERLIN-WOOL BUSINESS.
  5. THE BOOT AND SHOE TRADE.
  6. CONFECTIONERY BUSINESS.
      (_With Confectioners’ Receipts._)
  7. CORSET-MAKING BUSINESS.
  8. THE DRESS-MAKING BUSINESS.
  9. THE FANCY TRADE.
  10. FISH AND GAME TRADE.
  11. GLASS AND CHINA BUSINESS.
  12. THE JEWELLERY TRADE.
  13. LADIES’ UNDERCLOTHING AND BABY LINEN WAREHOUSE.
  14. THE MUSIC TRADE.
  15. SERVANTS’ REGISTRY BUSINESS.
  16. SHEFFIELD AND BIRMINGHAM GOODS TRADE.
  17. STATIONERY AND BOOKSELLING.
  18. THE TOY TRADE.
  19. MISCELLANEOUS TRADES.
  20. HOTEL MANAGING.
  21. THE LADY HOUSEKEEPER AND THE LADY HELP.
  22. HOME OCCUPATIONS.
  23. THE PLEASURES OF WORK.

  “The writer is evidently well informed, and her shrewd, practical
  hints cannot fail to be of value to an increasing class of the
  community, the women who are left to fight their own way in the
  world.”—_Echo._

  “This volume will be useful and cheering to many a woman thrown
  upon her own resources, by showing her what other women have done,
  and enabling her to discover in what direction she can best make
  use of her abilities.”—_Bristol Mercury._

  “Before going into any trade or profession women should consult
  this little work.”—_Sheffield Independent._

  “Claims our most marked attention.”—_Punch._

  “A shilling laid out in the purchase of this little book will
  prove a far better investment than the waste of postage stamps in
  replying to letters.”—_Stationer._

  “This is not a trumpery talk about business suitable for women, but
  a serious production, in which specific trades and occupations are
  dealt with in an intelligent and candid manner.”—_Manchester Weekly
  Post._

  “To those who find it needful to leave home and to enter upon
  the struggles of the world, the little book which ‘A Woman of
  Business’ has prepared will be found at once a guide and an
  encouragement.”—_Manchester Courier._

  “It fully fulfils its object in clearly showing the variety of
  businesses and lucrative employment which women may follow, as well
  as giving useful information as to how to start.”—_Weldon’s Ladies’
  Journal._

  “A volume which every woman who is at a loss to know how she may
  earn honourable livelihood should purchase.”—_Dundee Courier._


WITH EIGHT ILLUSTRATIONS ON TONED PAPER.

Fifth Edition, small crown 8vo., 384 pp., cloth, price 3s. 6d; gilt
edges, 4s.

  =The Secret of Success; or, How to= Get on in the World. With some
  Remarks upon True and False Success, and the Art of making the Best
  Use of Life. Interspersed with Numerous Examples and Anecdotes. By
  W. H. DAVENPORT ADAMS, Author of “Plain Living and High Thinking,”
  etc.

  “Mr. Adams’s work is in some respects more practical than Mr.
  Smiles’s. He takes the illustrations more from the world of
  business and commerce, and their application is unmistakable....
  There is much originality and power displayed in the manner in
  which he impresses his advice on his readers.”—_Aberdeen Journal._

  “There is a healthy, honest ring in its advice, and a wise
  discrimination between true and false success.... Many a story of
  success and failure helps to point its moral.”—_Bradford Observer._

  “The field which Mr. Adams traverses is so rich, extensive, and
  interesting, that his book is calculated to impart much sound
  moral philosophy of a kind and in a form that will be appreciated
  by a large number of readers.... The book is otherwise a mine of
  anecdote relating to men who have not only got on in the world, but
  whose names are illustrious as benefactors to their kind.”—_Dundee
  Advertiser._


WITH TWO COLOURED PLATES AND EIGHT PAGE ILLUSTRATIONS.

Third edition, small crown 8vo., 400 pp., cloth, price 3s. 6d.; gilt
edges, 4s.

  =Our Redcoats and Bluejackets: War= Pictures on Land and Sea.
  Forming a Continuous Narrative of the Naval and Military History
  of England from the year 1793 to the Present Time, including the
  Afghan and Zulu Campaigns, Interspersed with Anecdotes and Accounts
  of Personal Service. By HENRY STEWART, Author of “The Ocean Wave,”
  etc. With a Chronological List of England’s Naval and Military
  Engagements.

  “A capital collection of graphic sketches of plucky and brilliant
  achievements afloat and ashore, and has, moreover, the advantage of
  being a succinct narrative of historical events. It is, in fact,
  the naval and military history of England told in a series of
  effective tableaux.”—_World._

  “It is not a mere collection of scraps and anecdotes about our
  soldiers and sailors, but a history of their principal achievements
  since the beginning of the war in 1793. The book has charms for
  others than lads.”—_Scotsman._

  “Besides being a work of thrilling interest as a mere story-book,
  it will also be most valuable as a historical work for the young,
  who are far more likely to remember such interesting historical
  pictures than the dry lists of dates and battles which they find in
  their school-books.... Possesses such a genuine interest as no work
  of fiction could surpass.”—_Aberdeen Journal._

       *       *       *       *       *

“_Among the multitude of publishers who issue books suitable
for presents, Mr. Hogg holds a high place. A catalogue of his
publications, samples of which lie before us, contains a number of
useful and interesting works eminently suitable for presentation to
young people of both sexes, and they contain as much reading at as
low a price as any books in the market._”—PALL MALL GAZETTE.


WITH UPWARDS OF 300 ENGRAVINGS BY BEWICK AND OTHERS.

FIFTH AND CHEAP EDITION.

Large crown 8vo., 520 pp., cloth, price 3s. 6d.; gilt edges, 4s.

  =The Parlour Menagerie=: Wherein are exhibited, in a Descriptive
  and Anecdotical form, the Habits, Resources, and Mysterious
  Instincts of the more Interesting Portions of the Animal
  Creation. Dedicated by permission to the Right Hon. the Baroness
  Burdett-Coutts (President) and the Members of the Ladies’ Committee
  of the Royal Society for the Prevention of Cruelty to Animals.

  [Illustration: WHITE EYELID MANGABEY.

  _Specimen of the 66 Wood Engravings by Thomas Bewick in the
  “Parlour Menagerie.”_]

From Professor OWEN, C.B., F.R.S., &c.

(Director, Natural History Dep., British Museum).

To the Editor of the _Parlour Menagerie_.

  “The early love of Nature, especially as manifested by the Habits
  and Instincts of Animals to which you refer, in your own case, is
  so common to a healthy boy’s nature, that the _Parlour Menagerie_,
  a work so singularly full of interesting examples culled from so
  wide a range of Zoology, and so fully and beautifully illustrated
  cannot fail to be a favourite with the rising generation—and
  many succeeding ones—of Juvenile Naturalists. When I recall the
  ‘Description of 300 Animals’ (including the Cockatrice and all
  Pliny’s monsters) which fed my early appetite for Natural History,
  I can congratulate my grandchildren on being provided with so much
  more wholesome food through your persevering and discriminating
  labours.—RICHARD OWEN.”


From the Right Hon. JOHN BRIGHT, M.P.

To the Editor, _Parlour Menagerie_.

  “I doubt not the _Parlour Menagerie_ will prove very interesting,
  as indeed it has already been found to be by those of my family
  who have read it. I hope one of the effects of our better public
  education will be to create among our population a more humane
  disposition towards what we call the inferior animals. Much may be
  done by impressing on the minds of children the duty of kindness in
  their treatment of animals, and I hope this will not be neglected
  by the teachers of our schools.... I feel sure what you have done
  will bear good fruit.—JOHN BRIGHT.”

  “The _Parlour Menagerie_ is well named. Full as an egg of
  information and most agreeable reading and engravings, where before
  was there such a menagerie?”—_Animal World._

  “We have never seen a better collection of anecdotes and
  descriptions of animals than this, and it has the great advantage
  of numerous and admirable woodcuts. Pictorial illustrations form
  an important and valuable addition to any such collection. Those
  in the book before us are of remarkable excellence.... We highly
  commend the spirit which pervades the book, a spirit intensely
  alien to cruelty of every kind. On the whole, it is one of the
  very best of its kind, and we warrant both its usefulness and
  acceptability.”—_Literary World._

“_Mr. Hogg is, without question, a specialist in the art of catering
for the literary tastes of the young._”—SHROPSHIRE GUARDIAN.


WITH EIGHT ILLUSTRATIONS ON TONED PAPER.

Second edition, small crown 8vo., 352 pp., cloth, price 3s. 6d.; gilt
edges, 4s.

  =Boys and their Ways: A Book for and= about Boys. By ONE WHO KNOWS
  THEM.


CONTENTS.

  Chaps. 1. The Boy at Home.—2. The Boy at School.—3. The Boy in
  the Playground.—4. The Boy in his Leisure Hours.—5. Bad Boys.—6.
  Friendships of Boys.—7. The Boy in the Country.—8. How and What to
  Read.—9. Boyhood of Famous Men.—10. The Ideal Boy.

  “The table of contents gives such a bill of fare as will render
  the boy into whose hands this book falls eager to enjoy the feast
  prepared for him. We venture to predict for this charming book a
  popularity equal to ‘Self-Help.’... No better gift could be put
  into a boy’s hands, and it will become a standard work for the
  school library.”—_Scholastic World._

  “Who the author of the book is, has been kept a secret, and
  the anonymity we regret, because the work is one with which
  no writer need be ashamed to identify his name and stake his
  reputation.”—_Edinburgh Daily Review._

  “It is a boy’s book of the best style.”—_Aberdeen Journal._


WITH EIGHT PORTRAITS ON TONED PAPER.

_Dedicated by permission to the Rt. Hon. W. E. GLADSTONE, M.P., &c._

Third edition, small crown 8vo., 384 pp., cloth, price 3s. 6d.; gilt
edges, 4s.

  =Plain Living and High Thinking; or=, Practical Self-Culture:
  Moral, Mental, and Physical. By W. H. DAVENPORT ADAMS, Author of
  “The Secret of Success,” etc.


PART I.—MORAL SELF-CULTURE.

  Chap. 1. At Home.
   ”    2. Life Abroad.
   ”    3. Character.
   ”    4. Conduct.


PART II.—MENTAL SELF-CULTURE.

Chap. 1. How to Read.

  Chaps. 2 to 9. Courses of Reading in English Poetry, History,
  Biography, Fiction, Travel and Discovery, Theology, Philosophy and
  Metaphysics, Miscellaneous Science and Scientific Text-Books. Chap.
  10. How to Write: English Composition.


PART III.—PHYSICAL SELF-CULTURE.

“Mens sana in corpore sano.”

  “We like the thorough way in which Mr. Adams deals with
  ‘Self-Culture: Moral, Mental, and Physical.’ His chapter on the
  courtesies of home life, and the true relation between parent
  and child, is specially valuable nowadays. He certainly answers
  the question, ‘Is life worth living?’ in a most triumphant
  affirmative.”—_Graphic._

  “Books for young men are constantly appearing—some of them
  genuine, earnest, and useful, and many of them mere products of
  the art of book-making. We have pleasure in saying that this
  volume by Mr. Adams deserves to take its place among the best
  of the first-mentioned class. It is fresh, interesting, varied,
  and, above all, full of common sense, manliness, and right
  principle.”—_Inverness Courier._

  “Young men who wish to make something of themselves should invest
  seven sixpences in this most valuable volume.”—_Sword and Trowel._

  “A better book of the class in all respects we have seldom had the
  pleasure to notice.... We cannot too strongly recommend it to young
  men.”—_Young Men’s Christian Association Monthly Notes._

“_A glimpse through Mr. Hogg’s catalogue shows how admirably he
caters for the young of both sexes._”—WOLVERHAMPTON CHRONICLE.


  “The best book of the kind.”        }
  “A complete Society Encyclopædia.”  } _Vide Critical Notices._

With Frontispiece, small crown 8vo., 352 pp., handsomely bound in
cloth price 3s. 6d.; gilt edges, 4s.

  =The Glass of Fashion: A Universal= Handbook of Social Etiquette
  and Home Culture for Ladies and Gentlemen. With Copious and
  Practical Hints upon the Manners and Ceremonies of every Relation
  in Life—at Home, in Society, and at Court. Interspersed with
  Numerous Anecdotes. By the LOUNGER IN SOCIETY.

  CHAP.
  1. AT HOME.
  2. ABROAD.
  3. THE PHILOSOPHY OF DINNERS.
  4. THE BALL.
  5. THE PHILOSOPHY OF DRESS.
  6. THE ART OF CONVERSATION.
  7. THE ETIQUETTE OF WEDDINGS.
  8. AT COURT.
  9. HINTS ABOUT TITLES.
  10. A HEALTHY LIFE.
  11. TWO CENTURIES OF MAXIMS UPON MANNERS.
  12. THE HOUSEHOLD.

  “The most sensible book on etiquette that we remember to have
  seen.”—_Pall Mall Gazette._

  “This book may be considered a new departure in the class of works
  to which it belongs. It treats etiquette ‘from a liberal point of
  view,’ and amply fulfils its purpose.”—_Cassell’s Papers._

  “Useful, sensibly written, and full of amusing illustrative
  anecdotes.”—_Morning Post._

  “Creditable to the good sense and taste, as well as to the special
  information of its author.”—_Telegraph._

  “The book is the best of the kind yet produced, and no purchaser of
  it will regret his investment.”—_Bristol Mercury._

  “Those who live in dread lest they should not do the ‘correct
  thing’ should procure the book, which is a complete society
  encyclopædia.”—_Glasgow News._


WITH EIGHT ILLUSTRATIONS ON TONED PAPER.

Second edition, small crown 8vo., 352 pp., cloth, price 3s. 6d.; gilt
edges, 4s.

  =Girls and their Ways: A Book for and= about Girls. By ONE WHO
  KNOWS THEM.

  CHAP.

  1. THE GIRL AT HOME.

  2. THE GIRL IN HER LEISURE HOURS.

  3. THE GIRL AT SCHOOL—THE GIRL AND HER FRIENDS.

  4. THE GIRL ABROAD: CHARACTER SKETCHES.

  5. A GIRL’S GARDEN; IN PROSE AND POETRY.

  6. THE GIRL’S AMATEUR GARDENER’S CALENDAR; OR, ALL THE YEAR ROUND
  IN THE GIRL’S GARDEN.

  7. THE GIRL’S LIBRARY—WHAT TO READ.

  8. THE GIRL IN THE COUNTRY—PASTIME FOR LEISURE HOURS THROUGHOUT THE
  YEAR.

  9. WHAT THE GIRL MIGHT AND SHOULD BE: EXAMPLES OF NOBLE GIRLS FROM
  THE LIVES OF NOBLE WOMEN.

  “It aims high, and it hits the mark.”—_Literary World_.

  “Books prepared for girls are too often so weak and twaddly as to
  be an insult to the intellect of girlhood. This new work is an
  exception.”—_Daily Review_ (_Edinburgh_).

  “Worthy of a somewhat longer analysis than we shall be able to give
  it.... Parents will be benefited by its perusal as well as their
  daughters ... the more so that it is not written in a dry homiletic
  style, but with a living kindness and sympathy.”—_Queen._

  “A long list of books is given both for study and amusement. This
  list is selected with care and without prejudice, and should prove
  a great assistance to girls in doubt what to read.... It is a
  sensible and well-written book, full of information and wholesome
  thoughts for and about girls.”—_St. James’s Budget._

  “Home duties, amusement, social claims and appropriate literature,
  are subjects successively treated, and treated with both knowledge
  and sound judgment.”—_Pall Mall Gazette._

“_A wide field of variety, and some of the strongest elements
of romantic interest, are covered by and comprised in the books
published by Mr. Hogg._”—SCHOOL BOARD CHRONICLE.


Southey’s Edition, with Life of Bunyan, &c.

Illustrated with the Original Wood Blocks, by W. HARVEY.

Large crown 8vo., 402 pp., cloth, price 3s. 6d.; gilt edges, 4s.

  =The Pilgrim’s Progress. In Two= Parts. By JOHN BUNYAN. With
  Bibliographical Notes, and a Life of the Author, by ROBERT SOUTHEY;
  Portrait and Autograph of BUNYAN, and Thirty Wood Engravings by W.
  HARVEY, from the Original Blocks. The Text in large type (Small
  Pica). This is a reprint (with additional notes) of the edition
  published by John Major, London, 1830, at 21s., which was highly
  eulogized by Sir Walter Scott and Lord Macaulay.

  “This reprint, at a very moderate price, may be regarded as a
  popular boon.”—_Daily Telegraph._

  “An excellent edition of the great allegory. It contains Southey’s
  ‘Life,’ which certainly stands first for literary merit.”—_Pall
  Mall Gazette._

  “Costlier editions are on sale, but none produced with more taste
  than this one.”—_Dispatch._

  “A real service has been rendered for those who want a thoroughly
  readable copy of ‘The Pilgrim’s Progress.’”—_Literary World._

  “The whole book is reproduced in excellent fashion.”—_Scotsman._

  “This edition has exceptional claims upon public favour. The late
  poet laureate’s biography is in his best manner, while Harvey’s
  effective woodcuts are in themselves a feature of very considerable
  interest to lovers of British art. In the matter of typography and
  general get-up the reprint is in every respect superior to the
  original edition, and the low price at which the book is published
  should tempt many to obtain a copy. The binding and decorations are
  very effective, and the volume is fitted to grace any drawing-room
  table.”—_Oxford Times._


Second Edition, with Eight Engravings after Celebrated Painters.

Small crown 8vo., 392 pp., cloth, price 3s. 6d.; gilt edges, 4s.

  =The Church Seasons. Historically= and Poetically Illustrated. By
  ALEXANDER H. GRANT, M.A., Author of “Half-Hours with our Sacred
  Poets.”

  ☞ The aim has been to trace the origin and history of the Festivals
  and Fasts of the Ecclesiastical Year, and to illustrate in
  poetry the circumstances under which they began and continue to
  be celebrated, and the principal ideas and doctrines which they
  severally incorporate.

  “Our festival year is a bulwark of orthodoxy as real as our
  confessions of faith.”—PROFESSOR ARCHER BUTLER.

  “Mr. Grant’s scholarship is endorsed by authorities; his method
  is good, his style clear, and his treatment so impartial that
  his work has been praised alike by _Church Times_, _Record_,
  _Watchman_, _Freeman_, and _Nonconformist_. No words of ours could
  better prove the catholicity of a most instructive and valuable
  work.”—_Peterborough Advertiser._

  “The work shows very plainly that much care and judgment has been
  used in its compilation.... The intrinsic worth of its contents
  and their lasting usefulness admirably adapt it for a present. The
  eight engravings have been chosen so as to give examples of the
  highest samples of sacred art.”—_Oxford Times._

  “A very delightful volume for Sunday reading, the devotional
  character of the hymns giving an especial charm to the work. The
  historical information will be proved full of interest to young
  Churchmen, and young ladies especially will find the work to be
  one well adapted to inform the mind and gladden the heart.”—_Bible
  Christian Magazine._

  “Mr. Grant’s volume is worthy of high praise, alike for its careful
  research and its discriminative quotations. There is so much
  religious literature which is below the level of criticism, that we
  cannot but welcome a volume which commends itself to a cultivated
  Christian audience.”—_Echo._

“_Mr. John Hogg is always successful in producing an attractive array
of books for youthful readers, ... and we ought to add, that all his
publications are prettily got up._”—BRISTOL MERCURY.


WITH EIGHT ILLUSTRATIONS BY FRANK ABELL, PRINTED ON TONED PAPER.

Large crown 8vo., 422 pp., cloth, price 3s. 6d.; gilt edges, 4s.

  =The Adventures of Maurice Drummore= (Royal Marines), by Land and
  Sea. By LINDON MEADOWS, Author of “Whittlings from the West,”
  “College Recollections and Church Experiences,” “Jailbirds, or the
  Secrets of the Cells,” etc.

  “Every boy who is lucky enough to get these adventures once into
  his hands will be slow in parting with them until he has brought
  the hero safely home through them all.”—_British Mail._

  “A very good sort of story it is, with more of flavour than
  most.”—_World._

  “We have seen nothing in this book to contradict at least
  the latter part of an opinion quoted in the preface from a
  correspondent, that it is one of the cleverest, and one of
  the healthiest, tales for boys with which the writer was
  acquainted.”—_Spectator._

  “It is almost equal to Robinson Crusoe.”—_Sheffield Independent._

  “A capital story. The adventures are excellently told. Many of such
  books are mere imitations, and have no originality. Lindon Meadows’
  story has originality, and it is well worth reading.”—_Scotsman._

  “It has a distinct literary flavour, and is realistic in the best
  sense.”—_Athenæum._

  “Such works do much to stimulate a healthy chivalrous feeling in
  the breasts of a rising generation, and tend to make them both
  patriotic and full of endurance, under the many difficulties which
  they encounter in life.”—_Shrewsbury Chronicle._

  “We are inclined, after much deliberation, to call it the best
  book for boys ever written. Whoever wishes to give to a boy a book
  that will charm and enthral him, while imparting the noblest and
  healthiest impulses, let him choose ‘The Adventures of Maurice
  Drummore.’”—_Christian Leader._

  “It is thoroughly healthy, not ‘goody’ in the least; in short,
  just such a book as one would wish to place in the hands of a
  pure-minded, high-spirited boy.”—_Nottingham Guardian._

  “A thorough boy’s book, and the hero’s doings at school and in the
  Royal Marines are told with much vivacity, his adventures being
  many.”—_Glasgow Herald._

  “The book is simply crammed with adventures, frolic, and
  fun, depicted in racy style, and pervaded by a healthy tone,
  while its attractiveness is increased by some spirited
  illustrations.”—_Guernsey Mail and Telegraph._

  “A book that men will read with interest, and boys with an avidity
  which will probably not be awarded to any other book of the season.
  It would be a pity if the merits of such a story were lost in the
  crowd, and we trust it will receive the recognition which is its
  due.”—_Aberdeen Daily Free Press._


WITH EIGHT ILLUSTRATIONS ON TONED PAPER.

Small crown 8vo., 384 pp., cloth, price 3s. 6d.; gilt edges, 4s.

  =Exemplary Women: A Record of= Feminine Virtues and Achievements
  (abridged from “Woman’s Work and Worth”). By W. H. DAVENPORT ADAMS.

  CHAP.
    I. WOMAN AS MOTHER.
   II. WOMAN AS WIFE.
  III. WOMAN AS MAIDEN.
   IV. WOMAN IN THE WORLD OF LETTERS.
    V. WOMAN IN THE WORLD OF ART.
   VI. WOMAN AS THE HEROINE, ENTHUSIAST, AND SOCIAL REFORMER.

  “The qualifications and influence of women in different spheres of
  life are detailed and illustrated by notices of the lives of many
  who have been distinguished in various positions.”—_Bazaar._

“_The youth of both sexes are under deep obligations by the
publication of Mr. Hogg’s very interesting and attractive volumes.
It is a great object to attract the young to the habitual practice
of reading. That can only be accomplished by putting into their
hands books which will interest and amuse them, and at the same time
furnish them with useful knowledge, and with sound lessons of a
moral, judicious, and sensible character, calculated to be useful to
them as they advance in years._”—DUNDEE COURIER AND ARGUS.


WITH EIGHT ILLUSTRATIONS ON TONED PAPER.

Small crown 8vo., 384 pp., cloth, price 3s. 6d.; gilt edges, 4s.

  =The Ocean Wave: Narratives of some= of the Greatest Voyages,
  Seamen, Discoveries, Shipwrecks, and Mutinies of the World. By
  HENRY STEWART, Author of “Our Redcoats and Bluejackets,” etc.

  “Mr. Stewart’s new work comprises a selection of stories of the
  sea told in his best style and being historically accurate, ranks
  high among popular volumes intended to combine entertainment
  with instruction. To young and old alike the book ought to be
  profitable, for from it a very lucid account may be obtained of
  many of those momentous occurrences which have served to swell
  the history of England, and to afford an example to succeeding
  generations.”—_Bazaar._

  “A delightful volume of adventure. Rebellions and mutinies come
  jostling up against hair-breadth escapes and mournful disasters;
  while the south seas and the north, the equator and the poles, are
  all brought to notice by the judicious and able editor, MR. HENRY
  STEWART.”—_Bedfordshire Mercury._

  “It may fairly claim to be a popular volume, combining
  entertainment with instruction. The book is well written, the
  accounts of naval engagements are graphic and inspiring, and if no
  attempts have been made to write a systematic history of maritime
  enterprise, there is at all events presented a vast mass of
  information in an attractive form.”—_Athenæum._

  “A flight through the air on the enchanted prayer-carpet would not
  surpass in interest the movement of these narratives from ‘summer
  isles of Eden lying in dark purple spheres of sea’ to the iron
  coast of Nova Zembla.”—_Sheffield Independent._

  “A singularly interesting volume. The narratives are well told,
  and the illustrations plentiful; young people will be sure to like
  it, and will pick up from it, in a pleasant way, a good deal of
  historical information.”—_Guardian._

  “‘The Ocean Wave’ is far more interesting than nine-tenths of the
  story books. Coming down to more modern times, Mr. Stewart gives us
  some stirring episodes in the last American War, the moving tale
  of Arctic Exploration, from the time of Cabot to the Jeannette
  Expedition, and concludes a most interesting and useful volume with
  an account of the famous shipwrecks in recent times.”—_Literary
  Churchman._


WITH TWELVE ILLUSTRATIONS BY THOMAS STOTHARD, R.A., AND A PORTRAIT OF
DEFOE.

In one volume, 512 pp., large crown 8vo., cloth, price 3s. 6d.; gilt
edges, 4s.

  =The Life and Adventures of Robinson= Crusoe, of York, Mariner.
  With an Account of his Travels round Three Parts of the Globe.

  ☞ _A complete, unabridged Edition of both Parts, with no
  curtailment of the “Further Adventures.”_

  “A complete, unabridged edition of ‘Robinson Crusoe,’ in which
  something of the old tone, which has been to a great extent
  sacrificed in modern versions of this boy’s classic, has been
  revived. Twelve of the quaint illustrations by Thomas Stothard,
  engraved by Heath, are given, and are in themselves a sufficient
  reason for giving a specially hearty welcome to this edition of
  Defoe’s masterpiece. But the publication will, in the eyes of
  its young readers at all events, find a higher recommendation in
  the fact that the ‘Further Adventures’ have not been subject to
  their usual curtailment. A short biographical sketch of Defoe and
  Bernard Barton’s ‘Memorial’ of Robinson Crusoe are given by way of
  introduction, and add appreciably to the value of the edition. The
  book is excellently printed and bound.”—_Nottingham Daily Guardian._

  “It has every feature for becoming the boy’s favourite edition of
  ‘Robinson Crusoe.’”—_School Board Chronicle._

  “This handsome volume cannot fail to command an extensive sale;
  it contains both parts of the immortal hero’s adventures, and is
  therefore properly styled a ‘complete edition.’ A portrait and
  brief Memoir of Defoe precedes his tale.”—_Manchester Weekly Post._

  “This edition of ‘boyhood’s classic’ will take rank among the best.
  It contains twelve illustrations by Thomas Stothard, R.A., which
  are all good, and a portrait of Daniel Defoe, with a well written
  sketch of his life. Every boy should read ‘Robinson Crusoe,’ and
  will if he has the chance, and no better copy could be provided
  than the one published by Mr. Hogg.”—_Wesleyan Methodist Sunday
  School Magazine._

  “In no more complete or attractive style could it be presented
  than as issued the other day by Mr. Hogg. The volume makes fully
  500 pages, one half of the whole being taken up with the ‘Further
  Adventures,’ frequently abridged or omitted altogether from this
  ever fresh triumph of the story teller’s art. Printed on good
  paper, with large clear type, and radiant outwardly in purple and
  gold, this new edition is also illustrated with copies of a dozen
  drawings by Stothard and engraved by the elder Heath.”—_Glasgow
  Herald._


WITH SIX PORTRAITS PRINTED ON TONED PAPER.

Second edition, small crown 8vo., cloth, 288 pp., price 2s. 6d.; gilt
edges, 3s.

  =Plodding On: or, The Jog-trot to= Fame and Fortune. Illustrated by
  the Life-Stories of

  GEORGE PEABODY,
  JOHN KITTO,
  ROBERT CHAMBERS,
  CHARLES KNIGHT,
  HUGH MILLER,
  GEORGE ROMNEY,
  M. W. WATSON,
  THOMAS BRASSEY,
  ABRAHAM LINCOLN.

By HENRY CURWEN, Author of “A History of Booksellers,” etc.

  “We are glad to meet with a book of this kind, which has left the
  well worn tracks pursued by writers of similar works. There is a
  great variety in the characters of the different men whose lives
  are chronicled, and in the circumstances which surrounded them, but
  there is the common tie of a brave heart, a single purpose, and an
  indomitable will. The book is written in a manly, honest spirit,
  and should find a place in the library of every home.”—_Guernsey
  Mail._

  “A splendid book for boys and young men, illustrating, by the best
  method of all, life-histories, the way in which successful men have
  triumphed over early disadvantages, and have arrived at a great and
  good name and ample wealth by quiet perseverance in the path of
  duty.”—_Dundee Courier._

  “The biographical sketches are so presented as to bring out in a
  salient manner the great faculty these remarkable men have for hard
  and indomitable work. It is made evident that the greatness of a
  country and the progress of civilization grow out of the labour of
  such men.”—_School Board Chronicle._

  “These men are not idolized by Mr. Curwen, who does his work in
  sincerity and love. The former prevents the false hero-regarding
  which is too much the fashion, the latter imparts the author’s
  enthusiasm. Portraits add to the value of the half-crown
  volume.”—_Derbyshire Mercury._


HINTS FOR THE SELECTION OF CHRISTIAN NAMES.

Second edition, 176 pp., cloth, price 1s. 6d.

  =The Pocket Dictionary of One= Thousand Christian Names (Masculine
  and Feminine): with their Meanings Explained and Arranged in Four
  different Ways for ready Reference. With an Historical Introduction.

  1. MASCULINE NAMES, with their Meanings attached.
  2. FEMININE NAMES, with their Meanings attached.
  3. DICTIONARY OF MEANINGS—MASCULINE NAMES.
  4. DICTIONARY OF MEANINGS—FEMININE NAMES.

  ☞ _Every Parent should consult this Dictionary before deciding on a
  Child’s Name._

  “This will be a useful and interesting book for those who like to
  learn the meaning of their own and their friends’ appellations.
  Parents should purchase it, as it might help them to name their
  children a little more originally than they do.”—_Glasgow Herald._

  “A useful little etymological book. We observe that the compiler
  has gone to the best sources and authorities, and we recommend a
  perusal of his thoughtful preface as being full of suggestions for
  those who desire to study deeply his subject.”—_Manchester Weekly
  Post._

  “The idea is a good one, and well carried out, and the book should
  prove well worth its price to any parent in search of a suitable
  baptismal name.”—_Guernsey Mail._


“_A series of excellent books for boys is published by Mr. John Hogg,
London._”—SCOTSMAN.


_MR. ASCOTT R. HOPE’S NEW BOOKS._

“Mr. Ascott R. Hope now occupies the foremost place as a writer of
fiction for the schoolboy, and as he never produces a weak book,
and never disappoints his clients, his name is always a sufficient
passport.”—_School Board Chronicle._


WITH EIGHT ILLUSTRATIONS ON TONED PAPER.

Second edition, small crown 8vo., 384 pp., cloth, price 3s. 6d.; gilt
edges, 4s.

  =Stories of Young Adventurers. By= ASCOTT R. HOPE, Author of
  “Stories of Whitminster,” etc., etc.

  A YOUNG TURK.
  A WHITE INDIAN.
  A SLAVE BOY’S STORY.
  A SOLDIER BOY’S STORY.
  A SAILOR BOY’S STORY.
  A YOUNG YANKEE ON THE WAR PATH.
  FOUR SONS OF ALBION.
  A GIRL’S STORY.
  AN ADVENTURER AT THE ANTIPODES.
  AN ADVENTURER AT HOME.

“Mr. Hope is one of the best of living writers of boys’ books, and
we do not think we over-estimate the merits of the book before us if
we say it is one of his best. The idea is a happy one.... The result
is altogether as successful as the idea is happy.”—_Birmingham Daily
Post._

“Good, wholesome, stirring reading for boys of all ages. The scenes
of these adventures are laid in every quarter of the globe, and they
include every variety of peril.”—_World._

“Mr. Ascott Hope has hit upon a really excellent idea in his ‘Stories
of Young Adventurers,’ and carried it out with admirable success....
It would be difficult to pick out a better book of its kind; young
readers will hang over every page with an absorbing interest, and
all the time will be imbibing some useful historical information. We
should like to think that so thoroughly good a book will be in the
hands of a great many boyish readers.”—_Guardian._

“Sure to make the eyes of our boys gleam.... The tone is healthy and
robust, and for its kind the book is one of the best we know.”—_Sword
and Trowel._

“A debt of gratitude is due to Mr. Hope.... The work is as good as
the design.”—_Athenæum._


WITH EIGHT ILLUSTRATIONS ON TONED PAPER.

Small crown 8vo., 384 pp., cloth, price 3s. 6d.; gilt edges, 4s.

  =A Book of Boyhoods. By Ascott R.= HOPE, Author of “Our Homemade
  Stories,” etc.

  A NEW ENGLAND BOY.
  A BRAVE BOY.
  A FRENCH SCHOOLBOY.
  A SCHOOLBOY OF THE OLDEN TIME.
  A BLUECOAT BOY.
  A STABLE BOY.
  A REBEL BOY.
  A MYSTERIOUS BOY.
  A BLIND BOY.

  “Well planned, well written, and well named.... Mr. Hope has told
  these stories with much dramatic power and effect, and has produced
  a book which will delight all healthy-minded lads.”—_Scotsman._

  “Stories of all sorts of boys, who in different countries and
  circumstances, in peace or in war, at school or at work, at home or
  out in the world, by land or by sea, have gone through experiences
  worth relating.... The work is just such a volume as we would
  like to see in the hands of our schoolboys, and of those who are
  emerging into the busy haunts of business and anxiety.”—_Yorkshire
  Gazette._

  “Essentially of an attractive character to the youthful reader,
  and is, perhaps, as likely to interest the sisters as the
  brothers.”—_Bedford Mercury._


WITH EIGHT ILLUSTRATIONS ON TONED PAPER.

Small crown 8vo., 352 pp., cloth, price 3s. 6d.; gilt edges, 4s.

  =Our Homemade Stories. By Ascott= R. HOPE, Author of “Stories of
  Young Adventurers,” etc.

  “Mr. Hope throws himself instinctively into his most dramatic
  incidents from the boys point of view, and is humorous within the
  limits of their easy appreciation. We own to having laughed aloud
  over some of his drolleries; nor can anything be much better in
  this way than the dialogue in ‘My Desert Island.’”—_Times._

  “Mr. Hope understands boy nature through and through, and can get
  hold of their attention in a way entirely his own.... All manner of
  adventures at school, at home, and at sea, are narrated with equal
  vivacity and good sense.”—_Bookseller._

  “There is great variety in this volume, ... and the heroes are not
  model characters, but real boys.... There is a pleasant vein of
  humour running through the book that is unfortunately rare in tales
  for the young of the present day.”—_Manchester Examiner._

  “Romances of the kind which boys—yes, and girls too—will greatly
  enjoy.”—_Post._


WITH NINETEEN ILLUSTRATIONS BY GORDON BROWNE,

Small crown 8vo., 352 pp., cloth, price 3s. 6d.; gilt edges, 4s.

  =Evenings away from Home: A= Modern Miscellany of Entertainment for
  Young Masters and Misses. By ASCOTT R. HOPE, Author of “A Book of
  Boyhoods,” etc., etc.

  “No writer for boys surpasses Mr. Hope, and to tell boys he
  is here in strong force is to ensure the sale of a large
  edition.”—_Bedfordshire Mercury._

  “A _bonne bouche_ for boys. A right merry collection of short tales
  and sketches by Mr. Ascott R. Hope.”—_Daily Chronicle._

  “Just the kind of story to please the intelligent schoolboy or
  schoolgirl on the outlook for a little wholesome nonsense. The
  book is well got up, and the fantastical illustrations are likely
  to enhance it in the eye of the laughter-loving public.”—_School
  Newspaper._

  “Intended for young readers, and deserves the attention of those
  who provide prizes and replenish school libraries.”—_Wesleyan
  Methodist Sunday School Magazine._

  “A merrier book, with merrier pictures, one could not well
  imagine.”—_Newcastle Chronicle._

  “The glorious fun in these stories is quite irresistible. The
  illustrations are sure to set the table in a roar. The tales are
  supposed to be told by the boys themselves, and are amazingly well
  told. Mr. Hope’s name is already a household word.”—_Sheffield
  Independent._


WITH EIGHT ILLUSTRATIONS ON TONED PAPER.

Small crown 8vo., 352 pp., cloth, price 3s. 6d.; gilt edges, 4s.

  =Stories out of School-time. By Ascott= R. HOPE, Author of
  “Evenings away from Home,” etc.

CONTENTS:

  CHAP.
  1. FIDDLE-DE-DEE! A STORY OF HISTORY AND MYSTERY.
  2. VICTOR’S PONY: A STORY OF THE FRANCO-GERMAN WAR.
  3. ‘TO-MORROW’: A STORY OF THE HOLIDAYS.
  4. ALL BY HIMSELF: A STORY OF THE HIGHLANDS.
  5. OLD SCORES: A STORY OF THE CRIMEA.
  6. CHARLEY: A STORY OF MEMORY.
  7. BLACK AND WHITE: A STORY OF THE FIFTH OF NOVEMBER.
  8. THE WATCH: A STORY OF CHRISTMAS TIME.
  9. OUR SUNDAY AT HOME: A GIRL’S STORY.

  “Mr. Hope is a scholar, and his wide knowledge and culture give his
  books a _cache_ of their own.”—_Journal of Education._

  “We like Mr. Hope’s stories. They are fresh and healthy and
  vigorous. They can inspire no evil thought; they must encourage
  to good efforts; they are never dull; they are always amusing. A
  volume of stories of which this can be truthfully said needs no
  further commendation.”—_Scotsman._

  “If we must choose one story as being particularly good, it will be
  ‘Victor’s Pony.’ It is very clever and dramatic.”—_Saturday Review._

  “There is an old saying, that we must not tell tales out of school,
  but no schoolboy will quarrel with Mr. Ascott Hope for having
  broken the rule.”—_Literary Churchman._

  “No school library can be complete while Mr. Ascott Hope’s books
  are not in circulation.”—_Derbyshire Mercury._

  “The nine stories which make up this volume, without being of the
  too-goody sort, have one and all an instructive tendency which
  does not in the least diminish the interest both boys and girls
  will take in perusing them. Though these tales are more especially
  written for boys, not a few girls would read them with unmixed
  pleasure.”—_British Mail._

  “Excellent samples of what this ready writer can achieve. Not a
  story in this collection of nine drags or ends tediously. This is
  just the book for boys.”—_Christian World._

  “Mr. Hope thoroughly understands what kind of stories boys
  want, and what will please them. The various stories recounted
  in this new volume are all related in Mr. Hope’s inimitable
  way.”—_Nonconformist._


☞ _For Mr. Hope’s “Young Days of Authors,” see page 3._


_MR. MORWOOD’S NATURAL HISTORY BOOKS._

From the Royal Society for the Prevention of Cruelty to Animals.

  “I am directed by the Literature Committee to inform you that Mr.
  Morwood’s books (‘Facts and Phases of Animal Life’ and ‘Wonderful
  Animals’) are calculated greatly to promote the objects of this
  Society, and, therefore, it is our earnest hope that they will be
  purchased by all lovers of animals for circulation among young
  persons, and in public institutions.—JOHN COLAM, Secretary.”


WITH SEVENTY-FIVE WOOD ENGRAVINGS.

Small crown 8vo., 288 pp., cloth, price 2s. 6d.; gilt edges, 3s.

  =Facts and Phases of Animal Life, and the= Claims of Animals to
  Humane Treatment. With Original and Amusing Anecdotes. By VERNON
  S. MORWOOD, Lecturer to the Royal Society for the Prevention of
  Cruelty to Animals.

CHAP.

   1. WONDERFUL FACTS ABOUT ANIMALS.
   2. AT THE BOTTOM OF THE SEA.
   3. A HUNT IN OUR DITCHES AND HORSE-PONDS.
   4. BUZZINGS FROM A BEEHIVE.
   5. SPINNERS AND WEAVERS.
   6. BLACK LODGERS AND MINIATURE SCAVENGERS.
   7. INSECTS IN LIVERY, AND BOAT-BUILDERS.
   8. OUR BIRDS OF FREEDOM.
   9. OUR FEATHERED LABOURERS.
  10. IN THE BUILDING LINE.
  11. BIRD SINGERS IN NATURE’S TEMPLE.
  12. CHANTICLEER AND HIS FAMILY.
  13. MINERS OF THE SOIL.
  14. ACTIVE WORKERS, WITH LONG TAILS AND PRICKLY COATS.
  15. NOCTURNAL RAMBLERS ON THE LOOK-OUT.
  16. QUAINT NEIGHBOURS AND THEIR SHAGGY RELATIONS.
  17. OUR FURRY FRIENDS AND THEIR ANCESTORS.
  18. OUR CANINE COMPANIONS AND TENANTS OF THE KENNEL.
  19. RELATIONSHIP OF MAN AND ANIMALS.
  20. CAN ANIMALS TALK AND REASON?
  21. USEFUL LINKS IN NATURE’S CHAIN.
  22. CLIENTS WORTH PLEADING FOR. CLASSIFICATION, GLOSSARY, AND INDEX.

  “We have read parts of this work with great pleasure, and intend
  to go through it page by page for our own personal delectation.
  Two-and-sixpence will be well spent upon a book which teaches
  humanity to animals while it amuses the youthful reader.”—_Sword
  and Trowel._

  “A capital natural history book.”—_Graphic._

  “Crammed with good stories.”—_Sheffield Independent._


WITH EIGHTY-ONE ILLUSTRATIONS.

Small crown 8vo., 288 pp., cloth, price 2s. 6d.; gilt edges, 3s.

  =Wonderful Animals: Working, Domestic=, and Wild. Their Structure,
  Habits, Homes, and Uses—Descriptive, Anecdotical, and Amusing. By
  VERNON S. MORWOOD.

CHAP.

   1. CURIOUS ODDS AND ENDS ABOUT ANIMALS.
   2. PEEPS DOWN A MICROSCOPE.
   3. LILLIPUTIAN SUBJECTS OF THE ANIMAL KINGDOM.
   4. INSECT ARMIES, AND HOW RECRUITED.
   5. AN UNDERGROUND CITY OF LITTLE PEOPLE.
   6. FISH IN ARMOUR.
   7. FIRST COUSINS, OR OUR BIRDS IN BLACK.
   8. FEATHERED FEEDERS ON FISH, FLESH, AND FOWL.
   9. PEACEFUL MONARCHS OF THE LAKE.
  10. BIPED TENANTS OF THE FARMYARD.
  11. FOREST ACROBATS, LITTLE MARAUDERS, AND FLYING ODDITIES.
  12. FEEBLE FOLK, FISHERS, AND POACHERS.
  13. BRISTLY PACHYDERMS, WILD AND TAME.
  14. ARISTOCRACY OF ANIMALS.
  15. AN ANCIENT FAMILY.
  16. LOWINGS FROM THE FIELD AND SHED.
  17. FOUR-FOOTED HYBRIDS.
  18. OUR DONKEYS AND THEIR KINDRED.
  19. EVERYBODY’S FRIEND.
  20. ANECDOTES OF EVERYBODY’S FRIEND.
  21 AND 22. FOES AND FRIENDS OF ANIMALS.

  “This book is as full of anecdotes as a Christmas pudding is full
  of plums. Most of them are quite new. He is a poor fellow who does
  not regard all dumb creatures with a kindlier feeling after reading
  this entertaining book. It is worth a score detectives in the
  interests of humanity.”—_Sheffield Independent._

“_Mr. Hogg is a famous caterer in the way of books for youth. All his
books are excellent of their class; they are amply illustrated, and
it seems as though Mr. Hogg had resolved to be the special caterer in
healthy literature for the youngsters, and his publications are well
adapted to the various stages of youth of both sexes._”—INDIAN DAILY
NEWS.


_Dedicated by permission to the Royal Society for the Prevention of
Cruelty to Animals._

WITH FIFTY-NINE ILLUSTRATIONS.

128 pp., small crown 8vo., boards, price 1s.; or bound in cloth, 1s.
6d.

  =The Band of Mercy Guide to Natural= History. An Elementary Book
  on Zoology: Instructive, Amusing, and Anecdotical. By VERNON S.
  MORWOOD, Author of “Facts and Phases of Animal Life,” “Wonderful
  Animals,” etc., and Lecturer to the Royal Society for the
  Prevention of Cruelty to Animals.

  “It is an excellent idea to connect the knowledge of Nature with
  the thought of kindness and tenderness to dependent creatures. We
  welcome this volume as a means towards this end.”—_Spectator._

  “Its accurate statement of facts is combined with a number of
  amusing anecdotes, which are sure to rivet the attention of the
  juvenile reader.... We know of no better book of its class on this
  most interesting branch of study.”—_Guernsey Mail and Telegraph._

  “Satisfies a need which has been felt for some elementary work
  on natural history to interest the young folks who belong to the
  Band of Mercy. Plentiful engravings and popular lessons on birds,
  beasts and reptiles, with some anecdotes, make up this pleasant
  book.”—_Christian World._

  “Any book which advocates kindness to animals ought to find a
  warm welcome in the school and household. The book before us
  would form a good reading book for the upper standards in our
  Schools.”—_Literary Churchman._

  “One of the best shilling’s-worth in the market. It will teach our
  youngsters to be kind to all things that live.”—_Sword and Trowel._

  “A useful little book on natural history, simple and unpretentious
  in style, and copiously illustrated. There is no better
  preventative of cruelty to animals than a knowledge of their
  habits and characteristics, and books of this sort, therefore, can
  scarcely be multiplied too much.”—_Aberdeen Free Press._


WITH SEVENTY-EIGHT ILLUSTRATIONS.

Small crown 8vo., 288 pp., cloth, price 2s. 6d.; gilt edges, 3s.

  =Far-Famed Tales from the Arabian Nights’= Entertainments.
  Illustrated with Seventy-eight wood Engravings, and carefully
  revised for Young Readers.

  THE FISHERMAN AND THE GENIE.
  THE GREEK KING AND DAUBAN THE PHYSICIAN.
  THE VIZIER WHO WAS PUNISHED.
  THE STORY OF THE KING OF THE BLACK ISLES.
  THE STORY OF SINDBAD THE SAILOR; OR, THE OLD MAN OF THE SEA.
  THE SLEEPER AWAKENED.
  THE STORY OF ALADDIN; OR, THE WONDERFUL LAMP.
  THE ADVENTURES OF THE CALIPH HAROUN ALRASCHID.
  THE STORY OF BABA ABDALLA.
  THE STORY OF COGIA HASSAN ALHABBAL.
  ALI BABA AND THE FORTY THIEVES.

  “The print is good, there is a profusion of good illustrations,
  and the volume may be thoroughly recommended as well supplying
  an acknowledged want of a selection of the most familiar of the
  stories from the ‘Arabian Nights,’ in a form fit for childish
  reading.”—_Guardian._

  “A capital arrangement of some of the ‘Arabian Night’ Tales. Clear
  print, suggestive woodcuts and plenty of them, carefully edited
  versions—what more could be wanted?”—_Bedfordshire Mercury._

  “A selection of the best stories in the ‘Arabian Nights’
  Entertainments, illustrated with seventy-eight wood engravings.
  The compiler has executed his task with taste and skill, all
  objectionable passages having been removed without any loss of
  spirit.”—_Bristol Mercury._

  “There is nothing in this selection from the far-famed tales which
  young people may not be permitted to read. We envy the child who
  reads this book. Who is there, indeed, that can forget the time
  when he first read the adventures of Sindbad the Sailor, and the
  story of Ali Baba and the Forty Thieves? It is pleasant still to
  watch the dilating eyes of the youngsters as they pore over the
  old fictions, of which the volume before us contains a well-chosen
  selection.”—_Sheffield Independent._

“_The peculiarity of Mr. Hogg is that all his publications have a
healthy, moral tone, whilst most of them are eminently calculated
beneficially to impress the minds of both sexes. Commercially, the
publisher attaches to them a very modest value; mentally and morally,
the value cannot be estimated._”—LINCOLNSHIRE FREE PRESS.


WITH TWENTY-EIGHT ILLUSTRATIONS.

Small crown 8vo., 288 pp., cloth, price 2s. 6d.; gilt edges, 3s.

  =The Shoes of Fortune, and other Fairy= Tales. By HANS CHRISTIAN
  ANDERSEN. With a Biographical Sketch of the Author, a Portrait, and
  Twenty-seven Illustrations by OTTO SPECKTER and others.

  BIOGRAPHICAL SKETCH: HANS CHRISTIAN ANDERSEN, HIS LIFE AND GENIUS.
  THE SHOES OF FORTUNE.
  THE FIR-TREE.
  FIVE FROM A POD.
  THE STEADY TIN SOLDIER.
  TWELVE BY THE POST.
  THE FEARSOME UGLY DUCKLING.
  THE SHEPHERDESS AND THE CHIMNEY-SWEEP.
  THE SNOW-QUEEN, IN SEVEN STORIES.
  THE LITTLE OCEAN-MAID.
  THE ELFIN MOUND.
  OLD WINK, WINK, WINK.
  THE LEAP-FROG.
  THE ELDER BUSH.
  THE BELL.
  HOLGER DANSKE.
  THE EMPEROR FREDERICK BARBAROSSA.

  “The popularity of the fairy tales of Hans Andersen can never
  wane, and new editions of some of them can scarcely fail to be
  successful. Here is one published by Mr. John Hogg, with a very
  readable biographical sketch of the author by Dr. Kenneth Mackenzie
  (the original English edition of Andersen’s ‘In Sweden’), and a
  variety of illustrations, including a portrait.”—_St. James’s
  Gazette._

  “A volume which will be popular with young people. The stories are
  well selected, and there are some excellent illustrations in the
  book.”—_Scotsman._

  “This beautifully illustrated edition of Andersen’s exquisite
  stories is sure to be a favourite with all young people who become
  its fortunate possessors. The biographical sketch is admirably
  written.”—_Sheffield Independent._

  “We recommend all boys and girls who have not read about the
  wonderful Shoes of Fortune, and the Ugly Duckling and the Snow
  Queen, to get this book as soon as possible.”—_Literary Churchman._

  “The tales, of course, we need not criticise; but we may say that
  the illustrations are not unworthy of them. They show something
  of the same graceful fancy which guided Andersen’s pen. Of the
  singular personality of Andersen himself we get a really valuable
  sketch. Dr. Mackenzie estimates him justly, we think, but not
  unkindly.”—_The Spectator._


WITH PORTRAIT OF NATHAN MEYER DE ROTHSCHILD.

Second edition, crown 8vo., cloth, bevelled boards, price 2s. 6d.

  =Fortunate Men: How they made Money= and Won Renown. A Curious
  Collection of Rich Men’s Mottoes and Great Men’s Watchwords; their
  Financial Tests and Secrets; their Favourite Sayings and Guiding
  Rules in Business, with Droll and Pithy Remarks on the Conduct of
  Life, mostly taken down in their own words. To which is added many
  New and Authentic Sayings of “Poor Richard,” with Sundry Pieces of
  Useful Advice to Persons Entering the World, and Practical Hints
  for those Desirous of Improving their Position in it.

  “A chronicle of rank, and fame, and gold.”—_Punch._

  “The real value of its contents consists in its asserting the
  claims to respect of virtues, such as perseverance, method, and
  punctuality, which are often contemptuously treated, but which
  are invaluable, whether for making money or, which is much more
  important, for formation of character. With regard to the latter
  object, there is no question of substantial reward to the student,
  and we therefore wish the book success.”—_Glasgow Herald._

  “There is encouragement for others in its anecdotes, and its advice
  is dictated by morality and common-sense. To carry out its maxims
  might not ensure the making of a fortune during the present times
  of depression, but would secure an honourable business reputation
  under any circumstances.”—_Christian World._

  “He will be a dull and stupid boy indeed, who, whether fifty
  or fifteen years of age, does not learn something that will be
  valuable from ‘Fortunate Men.’”—_Manchester Weekly Post._

  “There are passages among these selections which are worthy to
  be inscribed in brass in every place of business. Of worldly
  wisdom we have here huge nuggets, and in the mingled mass much of
  pure gold may be seen. Every young man may read this book with
  profit.”—_Sword and Trowel._

“_As in every book which Mr. Hogg has sent us, so in this; we have to
praise the typography, the paper, and the strong but also ornamental
binding._”—MANCHESTER WEEKLY POST.


A HANDBOOK OF REFERENCE AND QUOTATION.

Second edition, fcap. 8vo., cloth, price 2s. 6d.

  =Mottoes and Aphorisms from Shakespeare=: Alphabetically arranged;
  with a Copious Index of 9,000 References to the infinitely varied
  Words and Ideas of the Mottoes. Any word or idea can be traced at
  once, and the correct quotation (with name of play, act, and scene)
  had without going further.

  “The collection is, we believe, unique of its kind.... It solves
  in a moment the often difficult question of where a proverb, or
  aphorism, or quotation from Shakespeare can be found.”—_Oxford
  Times._

  “As neat a casket of Shakespearian gems as we ever remember having
  met with.”—_Public Opinion._

  “The writer who delights now and then to embellish his productions
  by some of the well-pointed and telling mottoes and aphorisms from
  Shakespeare has here a most valuable book of reference.”—_Yorkshire
  Gazette._

  “Everything, in these cases, depends on the index, and the index
  here seems to have been carefully made.”—_Sheffield Independent._


New and enlarged edition, fcap. 8vo., cloth, price 2s. 6d.

  =A Practical Guide to English Versification=, with a Compendious
  Dictionary of Rhymes, an Examination of Classical Measures, and
  Comments upon Burlesque and Comic Verse, Vers de Société, and Song
  Writing. By TOM HOOD. A new and enlarged edition, to which are
  added Bysshe’s “RULES FOR MAKING ENGLISH VERSE,” etc.

  “We do not hesitate to say, that Mr. Hood’s volume is deserving of
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  of verse.”—_Daily News._

  “The book is compiled with great care, and will serve the purpose
  for which it is designed.... We may add that it contains a good
  deal of information which will be useful to students who have no
  wish to be numbered amongst verse-makers.”—_Pall Mall Gazette._

  “A dainty little book on English verse-making. The Dictionary of
  Rhymes will be found one of the most complete and practical in our
  language.”—_Freeman._

  “Alike to the tyro in versifying, the student of literature,
  and the general reader, this guide can be confidently
  recommended.”—_Scotsman._


Crown 8vo., cloth extra, bevelled boards, price 7s. 6d.

  =The Manuale Clericorum: A Guide for= the Reverent and Decent
  Celebration of Divine Service, the Holy Sacrament, and other
  Offices, according to the Rites, Ceremonies, and Ancient Use
  of the United Church of England and Ireland. Abridged from the
  “Directorium Anglicanum.” With Additions of Special Value in the
  Practical Rendering of the Services of the Church. Edited by the
  Rev. F. G. LEE.


Red Line Edition (the Fourth), with Illustrations, quarto, price 21s.

CAREFULLY REVISED, WITH NUMEROUS EMENDATIONS.

  =The Directorium Anglicanum: Being a= Manual of Directions for the
  Right Celebration of the Holy Communion, for the saying of Matins
  and Evensong, and for the Performance of other Rites and Ceremonies
  of the Church, according to ancient uses of the Church of England.
  Edited by the Rev. FREDERICK GEORGE LEE, D.C.L., F.S.A.

  “The existence of one such work of credit and reputation must
  do something to diminish the varieties of Ritualism into which
  the tastes or studies of independent explorers might lead
  them.”—_Guardian._




_PUBLISHING SEASON, 1885-6._

LIBRARIES FOR YOUNG READERS.


ASCOTT HOPE’S ANCHOR LIBRARY.

STORIES OF FACT AND FICTION.

[Illustration: Book Box]

TITLES OF THE VOLUMES.

  1. Our Homemade Stories.
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  4. A Book of Boyhoods.
  5. Stories out of School-time.
  6. Young Days of Authors.

☞ _Six Illustrated Volumes, price 3s. 6d. each; gilt edges, 4s. each._

_Or the whole in an Elegant Illustrated Metal Box, price 21s._


THE BOYS’ AND GIRLS’ TREASURY

Of Natural History, Fairy Tales, Biography, & Proverb Stories.

_BY POPULAR AUTHORS._

[Illustration: Book Box]

TITLES OF THE VOLUMES.

  =1. Facts and Phases of Animal Life, and the Claims of Animals to
  Humane Treatment.= By VERNON S. MORWOOD.

  =2. The Shoes of Fortune and other Fairy Tales.= By HANS C.
  ANDERSEN.

  =3. Wonderful Animals: Working, Domestic, and Wild.= By VERNON S.
  MORWOOD.

  =4. Far-famed Tales from the Arabian Nights.= Revised for Young
  Readers.

  =5. Plodding on; or, The Jog-trot to Fame and Fortune.= By HENRY
  CURWEN.

  =6 and 7. Proverb Stories for Boys and Girls.= Two Series. By
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  ☞ _Seven Illustrated Volumes, price 2s. 6d. each; gilt edges, 3s.
  each. Or the whole in an Elegant Illustrated Metal Box, price 17s.
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London: John Hogg, 13, Paternoster Row, E.C.




  Transcriber’s Notes
  pg 15 Changed spared to do their life work to: life-work
  pg 36 changed Dupuytreu’s to Dupuytren’s operations and instructions.
  pg 54 Changed he was also appointed Physician in Ordinary to:
    Physician-in-Ordinary
  pg 57 Changed have been appointed Physician Extraordinary to:
    Physician-Extraordinary
  pg 59 Changed being some time assistant physician to:
    assistant-physician
  pg 60 Changed in 1837 was made Physician in Ordinary to:
    Physician-in-Ordinary (2 places)
  pg 67 Changed He was made Physician Extraordinary to:
    Physician-Extraordinary
  pg 67 Changed  Physician in Ordinary to the Prince Consort to:
    Physician-in-Ordinary to the Prince-Consort
  pg 68 Changed was made Physician in Ordinary to: Physician-in-Ordinary
  pg 94 unneeded quote after not extinguished.
  pg 137 changed Dovoting to Devoting himself to physiological
  pg 151 Changed called in to attend the Prince Consort to:
    Prince-Consort
  pg 166 changed smallpox to small-pox before the discovery (2 instances
    of small-pox)
  pg 174 changed double to single quotes around the evidence of things
    unseen,
  pg 203 changed life-long to lifelong friend, say of him (3 instances
    of lifelong)
  pg 224 Added quote after state of his mind.
  pg 252 Changed Mackenzie was appointed Assistant Physician to:
    Assistant-Physician
  pg 261 fixed spelling of William Bowman, the third son
  pg 280 added “on” to taking his diploma went on a voyage
  pg 284 changed over-work to overwork and excess of feeling...
    (3 instances of overwork)
  pg 286 added . to Dr Gregory’s death...
  pg 298 changed spelling of phebitis to phlebitis. His report on...
  pg 308 Changed appointed Assistant Surgeon to St. George’s to:
    Assistant-Surgeon
  pg 310 changed spelling of Cruikshank to Cruickshank to match pg 53
  pg 310 changed ear years to early years, 72; under Ferguson, Sir
    William


  Advertisement pages
  pg 4 added missing quote after Robinson Crusoe,’ with Stothard’s
  pg 4 added missing quote after ‘a weak side’ to our sterling
  pg 9 changed single quote to double after may be of some service.”
  pg 11 changed word o to of, end of line I hope one of
  pg 13 changed single quote to double after special information of its
    author.”
  pg 14 changed principa to principal ideas and doctrines
  pg 14 changed ncorporate to: which they severally incorporate.
  pg 18 added period after “Mr. Hope throws himself
  pg 19 added ” after not in circulation.
  pg 20 added . after 9. our feathered labourers



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