HISTORICAL NOTE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Trigeminal neuralgia (Fothergill’s disease) in the 17th and 18th centuries

‘‘There is as exquisite an anguish suffered as from any
distemper to which the body is subject, if we may judge by
the expressions of it…’’ W Heberden, 18021

J
ohn Fothergill gave the first full and accurate description
of trigeminal neuralgia in 1773, but early descriptions of
trigeminal neuralgia (Fothergill’s disease)2 can be inferred

from the writings of Galen, Aretaeus of Cappadocia (born circa
AD 81), and in the 11th century by Avicenna (‘‘tortura oris’’).3

In the south aisle of Wells cathedral lies the tomb of Bishop
Button, who died in 1274. He was canonised. Many pilgrims
and toothache sufferers left offerings at the tomb, in
commemoration of which the capitals of the pillars bear
carvings of people depicted with facial neuralgia. One is
famed as the toothache figure. Because of the surprising rarity
of dental caries in that time (confirmed when the sarcopha-
gus was opened in 1848), Wilfred Harris pointed out the
probable relevance to trigeminal neuralgia.4

The most convincing early description5 in 1671 was of a
German physician, Johannes Laurentius Bausch, who suf-
fered from a lightning like pain in the right face. He became
unable to speak or eat properly and apparently succumbed to
malnutrition.

A marvellously detailed history is that of John Locke, the
famous physician and philosopher, who described the con-
dition in a series of letters to Dr John Mapletoft in 1677. His
account6 tells of his unfortunate patient, the Countess of
Northumberland, wife of the Ambassador to France.7

Nicolas André invented the term tic douloureux in 1756 in a
book,8 Observations pratiques sur les maladies de l’urethre et sur
plusiers faits convulsifs. André’s term remained though not all
patients showed the facial tics. Copies of John Fothergill’s
article are still available, but probably, only one copy of
André’s book exists—at the Wellcome Institute in London:

‘‘What had been regarded as the end of a mild and
tolerable ailment, became the source of the sharpest and
most uncomfortable pains, I would say the start of a tic
douloureux that assailed her night and day, deprived her of
sleep, and forbade her some of the bodily functions necessary
for life. In fact these periodic agitations became so frequent
that they rarely allowed five or six minutes of peace during
an entire hour; the patient could not eat, drink, cough, spit or
wipe her face without renewing her pains.’’

Nicolas André, John Fothergill(1712–1780),9 Samuel (his
nephew10), and Charles Bell were to elaborate the features,
possible causes, and treatments.

John Fothergill’s description of ‘‘a painful affection of the
face’’11 was presented to the Medical Society in London in
1773. The son of a Wensleydale farmer, having started his
career as a trainee apothecary, was persuaded to study
medicine. He read medicine at Edinburgh because as a Quaker
he was classed as a dissenter, which precluded admission to
English medical schools. He later studied at St Thomas’ hospi-
tal as a graduate. A highly successful and lucrative London
practice afforded him many opportunities. He described
angina pectoris in 1776, eight years after Heberden, and
diphtheria. He became a distinguished Quaker physician12 13

and plant hunter. He spent much of his earnings on acts of
philanthropy; and in the establishment of his botanical
garden at Upton, Essex, ‘‘known all over Europe’’,14 replete
with rare perennials and shrubs that he collected from
distant lands. He also acquired a large collection of rare shells
and minerals; Dr William Hunter purchased his collection on
his death. He generously supported many young doctors from

the American colonies. A friend of Benjamin Franklin, toge-
ther they tried unsuccessfully to avert the Revolutionary War.

Fothergill founded the Medical Society, a private conclave
of a few hospital physicians that should not to be confused
with the Medical Society of London, founded by Lettsome in
1773. John Fothergill described the complete clinical features
of trigeminal neuralgia, and he recorded that light touch was
the most common trigger. He had met with 14 cases and
attributed the cause to a ‘‘cancerous acrimony’’, because of
the persistence and incurability of the pain. He noted that it
was more common in women and the elderly. An essay by
Pujol15 confirmed his clinical description.

The diary16 of his young niece, Betty Fothergill, illustrates
his personality, and gives insights into his domestic life. The
diary portrays a high minded, humanitarian, scholarly but
liberal gentleman. A licentiate only, of the London College, he
was elected Fellow of the Edinburgh College of Physicians in
1754, and in 1763 became a Fellow of the Royal Society. He
died in 1780 from a second attack of ‘‘suppression of urine’’
and was buried in the Quaker burial ground at Winchmore
Hill. Hogarth’s distinguished cabinet portrait is in the London
College.

Samuel Fothergill too, wrote of this painful affliction in
1804 in An account of a Painful Affection of the nerves of the Face,
commonly called Tic Douloureux.17

Acknowledgement
I am grateful to Doreen Leach, Librarian, Royal College of Physicians,
London, for information on the Fothergills.

J M S Pearce
304 Beverley Road, Anlaby, Hull HU10 7BG;

jmspearce@freenet.co.uk

References
1 Heberden W. Commentaries on the history of cure of diseases. London:

T Payne, Mews-Gate, 1802:99. [Reprinted in Birmingham, AL: Classics of
Medicine Library; 1982:99.]

2 Stookey B, Ranshoff J. Trigeminal neuralgia: its history and treatment.
Springfield, IL: Charles C Thomas, 1959:10.

3 Lotfi J, Chaemmaghami AB, Minagar A, et al. Avicenna and his description of
trigeminal neuralgia. Neurology 2000;54(Suppl 3):A176 [abstract].

4 Harris W. The facial neuralgias. London, Milford: Oxford University Press,
1937:13–14.

5 Dewhurst K. A symposium on trigeminal neuralgia with contributions by
Locke, Sydenham, and other eminent seventeenth century physicians’ disease.
Ann J Hist Med Allied Sci 1957;12:21–36.

6 Lewy FH. The first authentic case of major trigeminal neuralgia and some
comments on the history of this disease. Ann Med Hist 1938;10:247–50.

7 Pearce JMS. John Locke (1632–1704) and the trigeminal neuralgia of the
Countess of Northumberland. J Neurol Neurosurg Psychiatry 1993;56:45.

8 André N. Traité sur les maladies de l’urèthre. Paris: Delaguette, 1756.

9 Booth CC. Three doctors and the American Revolution. Lancet
1967;12:358–64.

10 Fox R Hingston. Dr John Fothergill and his friends. London, MacMillan, 1919.

11 Fothergill J. Of a painful affection of the face. Medical observations and
inquiries by a society of physicians. London, 1773;5:129–142. [This
publication was funded privately by Fothergill from 1771–1776. It is included
in Complete Works of John Fothergill, a copy in library of RCP London.]

12 Fothergill J, Booth CC. Chain of friendship: selected letters of Dr John
Fothergill of London, 1735–1780. Harvard University Press, 1971.

13 Plaut GS. Dr John Fothergill and eighteenth-century medicine. J Med Biogr
1999;7(4):192–6.

14 Munk’s Roll. Lives of the Fellows of the Royal College of Physicians of London,
vol ii, 154–8 (John Fothergill), vol iii, pp.28.(Samuel Fothergill). London:
Published by the College, 1955.

15 Pujol M. Essai sur la maladie de la face nommée le tic douloureux. Paris:
Théophile Barrois, 1787.

16 Elkinton JR. Betty Fothergill and her ‘‘Uncle Doctor’’. An intimate glimpse of
Dr John Fothergill. Ann Intern Med 1976;85:637–40.

17 Fothergill S. An account of a Painful Affection of the nerves of the face,
commonly called Tic Douloureux, 8vo London. 1804. cited in Ref 13.

1688 J Neurol Neurosurg Psychiatry 2003;74:1688

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