ENGLISH LEADERS IN MEDICINE AND SURGERY DURING THE EIGHTEENTH AND EARLY NINETEENTH CENTURIES

First Group: Fothergill, Abernethy, James and John Douglass, Percival Pott and Sir Astley Cooper

The desire to start the science of medicine on a new course of growth seemed to develop at the same time in England that it did on the continent of Europe—that is, during the first half of the eighteenth century. The prolonged wars had for a long period of time turned men’s thoughts entirely aside from scientific inquiries of any kind; but, the moment the outlook seemed bright for a renewal of peaceful relations between the warring nations, there arose, among the men of the different sciences, a strong impulse to resume their normal labors in the various fields of research. Some of the evidences of the truth of this statement have been furnished in the earlier pages of the present work, and already, during the period which we have now reached in this brief historical sketch, the proofs are not lacking that the first fruits of this new harvest are before us and that we may safely form some idea as to their quality.

Of those who should be classed as physicians Fothergill and Abernethy certainly deserve to be named first. The latter, I am well aware, is usually classed among the surgeons, and he certainly deserves to be so classed; but he seems to me to occupy an equally high position as a medical philosopher.

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John Fothergill, one of the most distinguished English physicians of the eighteenth century, was born at Carr End, Yorkshire, March 8, 1712. He received his early medical training at Edinburgh, under the teaching of Monro, Alston, Sinclair and Plummer, all three of whom had been pupils of Boerhaave, at Leyden, Holland, and was given the degree of Doctor of Medicine by the University of Edinburgh, in 1736. During the years immediately following this event, he visited in turn the principal medical schools of Holland, Germany and France, and then settled definitively in London. In 1746 he met with marked success in the treatment of an epidemic of “putrid sore-throat,” which was raging in England at that period, and which showed a tendency to develop into a gangrenous condition. The physicians of that day employed largely purgatives and bloodletting in their treatment of this disease, but Fothergill depended mainly on the cautious use of emetics, mineral acids, bitters and light wines, the favorite practice among Spanish physicians. The success which attended his plan of treatment brought Fothergill a great increase in reputation as well as in fortune; and thus he was able, in 1762, to purchase at Upton, in Essex, a large tract of land which he developed into a splendid garden, where exotic plants of all sorts were cultivated. He also gathered at this place a very large collection of zoÖlogical and mineralogical specimens, which in the course of time became one of the most complete that was to be found anywhere in England. From 1765 onward, in order to relieve his health from the almost constant strain of so much business, he adopted the habit of absenting himself from London, regularly every year, for a period of two months; and with this object in view he chose for his retreat an attractive residence near Carr End, the town in which he was born. He died on December 26, 1780, at the age of sixty-nine, and bequeathed his entire fortune—aside from a modest stipend which he left to his sister—to the poor. The inscription written on his tombstone reads as follows: “Here lies Doctor Fothergill, who spent two-hundred thousand guineas for the relief of those in distress.” “I do not believe,” said the immortal Franklin, “that there ever existed a man who was better entitled to receive the esteem and veneration of all mankind than was Fothergill.” (Vicq-d’Azyr, in the Report of the SociÉtÉ Royale, of Paris.)

Fothergill did not write a single large treatise, but he published, in the Philosophic Transactions and elsewhere, no fewer than forty-one short memoirs on a great variety of topics.

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John Abernethy was born of Irish parents about the year 1764. In 1787 he was appointed Assistant Surgeon at St. Bartholomew’s Hospital, London, and was promoted to the position of Surgeon in 1815. From that date to 1827 he served the hospital with great distinction, attaining wide celebrity as a daring and skilful operator and also as a lecturer of great power. In his lectures he laid much stress upon two principles: First, that local diseases had a constitutional origin; and, second, that this origin could generally be traced to disorders of the digestive system.

George G. Sigmond, M.D., contributed to the London Lancet, of November 11, 1837, a brief but most satisfactory biographic sketch of Abernethy, and from this I copy such portions of the text as are likely to convey to my readers a more perfect picture of this great physician and surgeon than I could possibly provide by resorting to a mere compilation of the facts. Here is his account:—

Few individuals who have adorned our profession, possessed a more clear and accurate knowledge of the principles of our science than Mr. Abernethy, and no one ever explained them with greater simplicity, or with less of the entanglement of barbarous and uncouth names; he was, to the highest degree, plain, and, therefore, thoroughly intelligible. He had none of the deep learning and research of his two contemporaries, Dr. Young and Dr. Mason Good, but he was infinitely their superior in the explanation of his views, for he did not, as they have done, encumber his writings with the hard and unintelligible phrases of the Greeks, nor did he attempt to establish systems founded upon artificial arrangements. He watched the powers of Nature, he recalled the surgeon to the path of physic, he showed to him the effect of local disorders upon the constitution, and the reciprocal operation of constitutional disorders upon local diseases; he pointed out that the digestive organs may be affected by local disorder, and that upon the due functioning of these organs the health of man mainly depends. His object was to excite, by means of medicine, a more copious and healthy secretion.... To the knowledge of the necessity of great attention to the excretions, may chiefly be attributed the increased longevity of man, and his freedom from many of the diseases of former days.

Mr. Abernethy’s mode of pursuing his mercurial course [calomel and blue pill] was cautious and regular. He prescribed only small doses, taking care that the error so often fallen into, of increasing the quantity, when any benefit was perceptible, should be avoided.

His death occurred in 1831.

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James Douglass, who was born in Scotland in 1675, died in London in 1742. During his residence in the English metropolis he practiced midwifery and taught anatomy. He was one of those exceptional men (like John Hunter, for example) who were able both to practice the art of medicine and to do a great deal of research work. Among other things he interested himself in the history of medicine and also took high rank as a botanist. The following list of the titles of some of his more important contributions to medical literature illustrate his great versatility:—“Myographiae comparatae Specimen,” or “a comparative description of all the muscles in a man and in a quadruped,” London, 1707; “Description of an Instrument for Extracting Teeth,” in the Philosophical Transactions, Vol. V.; “History of the Lateral Operation for Extracting the Stone by making a Wound near the Great Protuberance of the Os Ischii,” London, 1726; “A Description of the Peritonaeum and of that part of the membrana cellularis which lies on its outside, with an account of the true situation of the abdominal viscera,” London, 1730; “Appendix to the History of the Lateral Operation for the Stone,” London, 1731.

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John Douglass, a younger brother of the preceding, also became celebrated as a surgeon. He lived in London, was connected with the Westminster Hospital, and attained special distinction through his having revived—after the lapse of nearly two centuries—the suprapubic operation for stone in the bladder (Pierre Franco’s “haut appareil”). His first operation of this nature was performed in 1719. John Douglass died in 1759.

His best-known published treatise bears the title: “Lithotomia Douglassiana,” or a “New Method,” etc., London, 1719.

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Percival Pott was born at London on December 26, 1713. Four years later his father died, leaving his widow and son in possession of very scanty means. In 1729, when sixteen years of age, Percival was bound an apprentice to Mr. Nourse, one of the younger surgeons of St. Bartholomew’s Hospital and a lecturer on anatomy in a private medical school which he established in the heart of London. As it was Pott’s duty to prepare the subjects for demonstration he thus enjoyed unusual opportunities for grounding himself well in the knowledge of anatomy. At the same time, through his relationship with Mr. Nourse, he found unlimited opportunities in the hospital for witnessing surgical operations and for becoming thoroughly familiar with disease in its different forms. English surgery at this early period was very crude and unscientific, and—as will be readily understood—most painful. In his study of different surgical affections Pott followed the plan advocated by Lord Bacon, viz., to take up one subject or one region of the body at a time and to devote all his attention to that particular subject or region until he had exhausted all available sources of information relating to the subject.

In 1736, having finished his apprenticeship, he began at once making the necessary preparations for entering upon the practice of his profession. For his residence and place of business he rented an attractive-looking house in a good part of London, and took with him his mother and her daughter by her first husband. Thanks to the brilliancy of his talents, to an untiring industry and to an attractive personality and agreeable manners, he soon won for himself a considerable clientÈle; while at the same time acquiring many friends among the most influential members of his own profession as well as among the Élite of London society in general. These early friendships, says his biographer, proved to be permanent; indeed, it may be claimed that few physicians acquired and retained through life more firm or more respectable friends.

In 1744 Pott was elected an Assistant Surgeon, and in 1749 one of the Principal Surgeons, of St. Bartholomew’s Hospital. From 1744 to 1787 he was unremitting in the surgical work which he performed in this institution. One of the most important services which he rendered to the science of medicine may justly be said to consist in the additions which he made to the scanty knowledge of that period concerning the nature and proper treatment of that disease of the spinal column which for many years has borne the name—in honor of this distinguished surgeon—of “Pott’s disease of the spine.” His first published memoir concerning the disease was published in 1779; but it was, as might be expected, only a preliminary sketch of the subject. Four years later he gave a complete description of this affection, the importance of which had for such a long period not been properly appreciated. In 1786 he received from the Royal College of Surgeons in Edinburgh a diploma accompanied by a letter expressive of the high degree of appreciation in which he was held by that institution. This honor was greatly enhanced by the fact that Pott was the first person on whom it had been conferred.

Pott’s biographer (Sir James Earle, Surgeon Extraordinary to the King) places the following estimate upon his character and upon his attainments as a surgeon:—

He was the most eminent of his time as a writer, as a teacher, and as a practitioner in surgery; and his merits in each of these characters were most extensive. Possessed with an enthusiastic love of excelling, without which genius is inert, he was not contented with any kind of mediocrity in himself.

As an author, his language is correct, strong and animated.... He introduces anatomy and physiology, whenever it is necessary, to illustrate and distinguish diseases; but never confuses his reader with uncertain hypotheses in pathology, founded on physiological principles. He was of opinion, and it is the opinion of Newton, that hypothesis has no place in any physical science.... His remedies always strongly marked his intention; they were decided and consistent; and he was the principal author of that simplicity which distinguishes the present practice from that of our ancestors....

As a teacher, he had acquired the faculty of speaking readily, with great point and energy, of delivering the most prolix and intricate sentences with incredible perspicuity and correctness, and of enforcing what he said with a most harmonious and expressive elocution....

As a practioner in surgery, we must apply to him all the essential qualifications—sound judgment, cool determination and great manual dexterity....

In the transaction of business there was a freedom and openness in his manner, which evidently arose from a consciousness that the opinion which he delivered was founded on experience.... This conduct in all situations was an appeal to the good sense of mankind. Thus he acquired the universal confidence of the profession; and, without any accidental or external help, he raised himself to the greatest dignity which man can attain—the first rank in a liberal profession.

Percival Pott wrote a treatise on the necessity of amputation in certain cases, and in this he strongly refutes the opinion of a Prussian army surgeon who maintained that in almost any case it was not necessary to amputate. The title of the treatise in which this opinion is expressed is “De membrorum amputatione rarissime administranda, aut quasi abroganda.” Shortly afterward Dr. Tissot, of Lausanne, Switzerland, spoke in even stronger terms against this surgical procedure, even going so far (see his treatise entitled “Sur l’inutilitÉ de l’amputation des membres”) as to urge surgeons to abandon the “murderous and cruel method of amputation”—Pott’s criticism of the views expressed by these two writers is most charitable: “However, as we must suppose that the doctrine which these gentlemen have promulgated arose from humane motives, and upon a conviction of its being well founded, we must at least applaud their intention, though we cannot approve their judgment.”

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Astley Cooper was born at Brooke, in Norfolk, England, August 23, 1768. As a boy he was fond of all the sports that are commonly cultivated at English schools, and even at that early age he manifested a bold and enterprising spirit, and yet at the same time he was noted for his social and friendly spirit. His biographer, Pettigrew, who witnessed many of the operations which Sir Astley performed at Guy’s Hospital in the earlier years of his career, speaks in strong terms concerning the impression which he made upon the regular pupils and the casual physicians who from time to time attended him on his rounds through the hospital:—

I can never forget the enthusiasm with which he entered upon the performance of any duty calculated to abridge human suffering. This enthusiasm, by the generosity of his character, his familiar manner, and the excellence of his temper, he imparted to all around him—the pupils imbibed the same spirit; and the extent of the obligations of the present and of after ages to Sir Astley Cooper, in thus forming able and spirited surgeons, can never be accurately estimated.

He was the idol of the Borough School—the pupils followed him in troops, and, like to Linnaeus, who has been described as proceeding upon his botanical excursions accompanied by hundreds of students, so may Sir Astley be depicted traversing the wards of the hospital with an equal number of pupils, listening with almost breathless anxiety to catch the observations which fell from his lips upon the several cases presented to his view. But, on the days of operation, this feeling was wound up to the highest pitch—the sight was altogether deeply interesting; the large theatre of Guy’s crowded to the ceiling—the profound silence obtained upon his entry—that person so manly and so truly imposing—and the awful feeling connected with the occasion—can never be forgotten by any of his pupils. The elegance of his operation—without the slightest affectation—all ease—all kindness to the patient, and equally solicitous that nothing should be hidden from the observation of the pupils—rapid in execution—masterly in manner—no hurry—no disorder—the most trifling minutiae attended to—the dressings generally applied by his own hand ... Sir Astley was, at that time (about 1805–1810), decidedly one of the first operators of the day, and this must be taken in its widest sense, for it is intended to include the planning of the operation, the precision and dexterity in the mode of its performance, and the readiness with which all difficulties were met and overcome.

Among the contributions which Sir Astley made to the science of medicine the following deserve to receive special mention:—In 1798 he published the report of a remarkable case of strangulated hernia in which a part of the abdominal viscera was protruded into the left cavity of the chest, through an opening in the diaphragm. The viscera were much displaced from their natural situation, and the great arch of the colon, together with a large portion of the omentum, was pushed through the aperture in the diaphragm. The existence of this opening, which represented a congenital malformation, was first ascertained after death. It seems almost needless to add that, even if this unusual condition of the parts had been known during the patient’s lifetime, no possible means of relief could have been afforded.

Another of Sir Astley’s contributions—one, namely, which he published in 1804—deals with the subject of inguinal hernia, a topic concerning which very little was known before Cooper’s time. The Spanish surgeon, Gimbernat, had—it is true—published at a still earlier date a masterly description of the anatomy of the parts concerned in this form of hernia, but the fact had been entirely forgotten until Sir Astley called attention to its importance. Mr. Lawrence, the distinguished English surgeon, makes the statement (1806) that “no complete description and accurate delineation of even the common kinds of hernia, as the inguinal, femoral, and umbilical, existed previously to the late excellent works of Camper, Cooper, Scarpa, Hesselbach, Cloquet and Langenbeck.”

In Vol. I. of the Transactions of the Medico-Chirurgical Society (1808) will be found a report, by Sir Astley, of two cases of aneurism of the carotid artery. Pettigrew says that the first of these two cases was treated by ligature upon the vessel—the first of the kind on record, and establishing a practice which has since been pursued and successfully adopted. The second one of the two cases mentioned at the beginning of this paragraph—also a case of aneurism of the carotid—was treated by ligature and with a completely successful result. This patient lived until 1821, at which time Sir Astley published an account of the dissection made by him of the parts involved in the region of the earlier aneurism.

Sir Astley Cooper is the first surgeon to whom we are indebted for the performance of an operation designed to remedy in a measurable degree—in a few cases even to cure—the malformation known as Spina bifida, a condition which consists of a deficiency of the spinous processes of the vertebrae by which the theca enclosing the spinal marrow distends and protrudes to such a degree as to form a tumor, any opening into which has been commonly considered as necessarily attended by fatal effects. Sir Astley attributes the successful issue of the cases under his care to the employment of needles, and not the lancet, to discharge the fluid.

Many other instructive cases were reported by Sir Astley in later years, but the lack of space does not permit me to mention them here. It is enough for me to state that in his “Lectures on the Principles and Practice of Surgery” (published by Mr. F. Tyrrell, Surgeon of St. Thomas’s Hospital) very full details are furnished concerning all of Sir Astley’s operative work.

Among the honors conferred upon this distinguished surgeon during the later years of his life the following deserve to be mentioned: President of the College of Surgeons in 1827; Surgeon to the King in 1828; and Vice-President of the Royal Society in 1830. His income is said to have risen in 1813 to the very large sum of £21,000 ($105,000). His death occurred in 1841.