THE RE16N OF GEORGE III 
 
 HAPL1N 
 
 b.)
 
 umber of Copy 
 
 3 YORK GATE, 
 
 LONDON, N.W.
 
 MEDICINE IN EN6LAND 
 
 DURING THE 
 
 REIGN OF GEORGE III 
 
 THE FITZPATRICK LECTURES DELIVERED 
 
 AT THE ROYAL COLLEGE OF PHYSICIANS 
 
 1917-1918 
 
 BY 
 
 ARNOLD CHAPLIN, M.D. (CANTAB.) 
 
 FELLOW OF THE COf.LKGK 
 
 LONDON 
 HENRY KIMPTON 
 
 263 HIGH HOLBORN W. C.
 
 Copyright 
 
 All riylttx 

 
 MEDICINE IN ENGLAND 
 DURING THE REIGN OF GEORGE III 
 
 CHAPTER I 
 
 GENERAL CONDITIONS MEDICAL EDUCATION 
 
 THE sixty years of the reign of George III witnessed vast 
 intellectual changes which closed for ever the long period 
 of feudalism. They saw the practical application of 
 methods of thought which had been taking definite 
 shape for the past hundred years. They heard the 
 death-knell of principles which had enthralled and 
 fettered Europe for centuries, and they saw the founda- 
 tions laid of those conceptions of civil and intellectual 
 liberty which have since governed the world. It was an 
 age of men of predominant genius who assailed with 
 splendid courage the last strongholds of reaction and 
 opposition to human progress ; an age in which the 
 principle was firmly established that free enquiry was 
 the only sure road to the advancement of knowledge, 
 toleration of opinion, and liberty of action. 
 
 But although this spirit of free enquiry was abroad 
 in the land, and although its cause was championed by 
 some of the mightiest intellects of that or of any other 
 age, for a considerable time its victory hung in the 
 balance, and, in any case, its full fruition was post- 
 poned for a number of years. For, in the course of its 
 advance, the spirit of free enquiry met with a most 
 powerful and determined opposition in the shape of a
 
 2 MEDICINE IN ENGLAND 
 
 reactionary spirit which stood sullenly at bay in its 
 last defences, and during the last thirty years of the 
 eighteenth century nearly succeeded in wrecking the 
 whole movement. Every artifice that the wit of man 
 could devise to check the march of progress was used by 
 the reactionaries. They suspended the right of " habeas 
 corpus," they prohibited the right of freedom of speech, 
 and the right of freedom of the press, and, by the main- 
 tenance of the hateful Test and Corporation Acts, and 
 other repressive measures against those who professed 
 unorthodox faiths and opinions, they practically de- 
 stroyed all semblance of civil, intellectual, and religious 
 liberty. 
 
 Then again this age is, perhaps, better known to us 
 than any other in the annals of our history, and its 
 close proximity to our own will surely enlist a measure 
 of our interest and sympathy. The opulence of its 
 literature has made us familiar with its customs, its 
 manners, its great men, and its great women. The 
 lives led by the people of that time, their formal old- 
 world courtesy, their robustness of character, even 
 their foibles, all appeal to us, and occupy a share of our 
 affections. Finally, the age of George III is adorned 
 by some of the greatest names this country has ever 
 produced. It is hallowed by the memory of Burke, the 
 first of all political philosophers, of Fox, the foremost 
 champion of civil and religious liberty, of the stately 
 Gibbon, of the endearingly simple Goldsmith, of the 
 quartet of great Scotsmen, Hunter, Hume, Adam Smith, 
 and Robertson, and of the commanding and representa- 
 tive personality of Johnson, better known, and dearer 
 to us, perhaps, than any other. 
 
 If the foregoing be admitted as a true interpretation 
 of the spirit of the age of George III ; if it be granted 
 that this age witnessed great general changes in thought 
 and action, great advances in human progress, and the 
 birth of that social and intellectual state under which
 
 DURING THE REIGN OF GEORGE III 3 
 
 we at present live ; then it will surely follow that the 
 same processes were in operation in the particular 
 realm of medicine, and produced most important 
 changes therein. It becomes, therefore, a matter of 
 interest and profit to trace these changes in the medical 
 profession, for from such a study evidences will be found 
 of the inception of many customs, methods, and theories 
 which have become accepted facts at the present time. 
 
 In order to accomplish this purpose it is proposed to 
 give a description of the state of medicine at this period. 
 After offering some brief preliminary observations con- 
 cerning the general intellectual conditions which ex- 
 erted an influence on medical thought in the eighteenth 
 century, the special conditions under which medicine 
 flourished during the reign of George III will be dealt 
 with at some length. This part of the subject will 
 include an enquiry into the state of the medical pro- 
 fession as it existed at that time. It will treat of the 
 position of the Royal College of Physicians ; of the 
 facilities for the acquirement of medical knowledge in 
 London and at the Universities ; of the rise and pro- 
 gress of the hospitals, the dispensaries, the societies, 
 and the medical press. An account will be given of the 
 work of physicians who contributed to the advance of 
 the knowledge of medicine, pathology, obstetrics, 
 lunacy, and dermatology ; of the work of those 
 physicians who advanced general science ; and of the 
 personal and mental attributes of those who adorned 
 the medical profession by reason of attainments other 
 than scientific and medical. Space will also be devoted 
 to the development of the medical services of the Navy 
 and Army, for during the age of George III many of 
 the fundamental principles which govern those services 
 at the present day were formulated and instituted. 
 Lastly, some account will be given of the illnesses of 
 some distinguished Georgians, with special reference to 
 the diagnoses made and the treatment administered.
 
 4 MEDICINE IN ENGLAND 
 
 The proper appreciation of the particular quality of 
 medical thought during the age of George III involves 
 a consideration of all thought and literature at that 
 time. The last half of the eighteenth century was an 
 age of transition, in which the human intelligence re- 
 fused to be satisfied with mere speculations, in which it 
 objected to accept ideas as true on the " ipse dixit " of 
 so-called authority, and in which it evinced an over- 
 mastering craving for proof. In the latter half of this 
 century doctrines which had withstood the assaults of 
 ages were seen to crumble and wither when subjected 
 to the unrelenting process of investigation founded on 
 a secure scientific basis. The same scientific method 
 carried the thoughts of men to heights hitherto un- 
 sealed, and opened up vistas of knowledge never before 
 conceived. The honour of having wrought this change 
 in thought belongs to the French school, of which 
 the chief exponents were Voltaire, Montesquieu, and 
 Rousseau. These men nurtured and brought to fruition 
 the spirit of free enquiry and toleration, and, although 
 they borrowed the idea from Locke, Hobbes, and others 
 in this country, they are nevertheless entitled to praise 
 for having clothed it with their genius and imagination. 
 The first evidence of a change came in the domain of 
 historical writing. Owing to the influence and incessant 
 labours of Voltaire history for the first time came to 
 be written from a rational standpoint. In his " Le 
 Siecle de Louis XIV " for the first time it was no longer 
 a narration of the trivial acts and peculiarities of kings 
 and captains, but an exhaustive enquiry into the 
 manners, customs, and economic conditions governing 
 the destinies of peoples. After this, almost every branch 
 of literature and thought was involved in the same 
 change, until, in the closing years of the eighteenth 
 century was witnessed the final emancipation of the 
 human intellect, the last struggles of feudalistic prin- 
 ciples, and the dawn of civil, intellectual, and religious
 
 DURING THE REIGN OF GEORGE III 5 
 
 freedom. This beneficent stream of unfettered thought 
 was, at first, without channels, and with the flood-gates 
 wide open, it bid fair to swamp the very things it was 
 intended to conserve and foster. But as time went on 
 it became more and more directed until, early in the 
 nineteenth century, it was so controlled that its full 
 benefits became manifest in every department of life 
 and thought. In a word, the spirit of free enquiry 
 became universal, and the days of mere speculation 
 were numbered. 
 
 When the evolution of medical thought during this 
 epoch is considered, little difficulty is experienced in 
 instituting a parallel with the change that had taken 
 place in intellectual Europe. Until the end of the 
 eighteenth century the spirit of scientific enquiry and 
 the desire to appeal to facts ascertained by experiment 
 did not influence medical thought to any great extent. 
 Harvey, the glory of the College of Physicians, was so 
 in advance of his times that he was doomed to wait a 
 century for that suitable soil on which his seed could 
 come to fruition. Indeed, the conclusion is warranted 
 that medical thought during the first half of the eigh- 
 teenth century accomplished scarcely anything that has 
 withstood the test of time. The theories of medical 
 science promulgated at this time were often the results 
 of metaphysical speculations, and little or no attempt 
 was made to submit them to the supreme test of scien- 
 tific proof. For this reason the "Systems," raised up with 
 so much labour, and at the expense of such great philo- 
 sophical ability, were soon swept away when tested by 
 the experimental method. 
 
 It is not proposed to deal at any considerable length 
 with the various Systems which arose during the first 
 half of the eighteenth century, and, for a time, exerted 
 a certain influence over medical thought. Although 
 they may be interesting as landmarks and signposts 
 on the road of physiological and chemical progress, yet,
 
 MEDICINE IN ENGLAND 
 
 since they were founded, for the most part, on mere 
 speculation, they often retarded a just conception of 
 the principles of medicine. Some of these Systems were 
 entirely new, while others were of a composite variety, 
 and made up of the most likely elements of former 
 Systems. The " Animism " of Stahl, the " .Ether " of 
 Hoffmann, the " Solidism " of Cullen, the " latro- 
 Chemical," the " latro-Physical," and the "Old Vienna" 
 schools, all had their votaries and enjoyed a brief popu- 
 larity. But the illuminating teaching of Harvey and 
 Sydenham had fallen upon deaf ears, and the doctors 
 were still engaged in speculating in the quiet of their 
 studies, instead of seeking for information in the book 
 of nature. 1 
 
 After giving due attention to these various Systems 
 it must be confessed that one rises from the task with 
 a feeling of sadness sadness that such powerful in- 
 tellects wasted their abilities on work calculated so 
 little to contribute to the real advancement of medical 
 knowledge. Indeed, to express shortly our view of the 
 effects produced upon medicine by the Systems, a 
 passage from Lord Morley's " Voltaire " might be 
 adopted with but slight substitution of words. " For 
 all the Systems we see only dismal tracts of medical 
 darkness, we hear only the humming of the doctors as 
 they serve forth, 'to men thirsting after knowledge, the 
 draff of a medical superstition." 
 
 The comparative absence of medical advancement 
 during the first half of the eighteenth century can 
 scarcely cause astonishment if the particular education 
 and environment of physicians at that time be taken 
 into account. Those who championed the new scientific 
 method of enquiry were never weary of pointing out 
 
 1 It is not, of course, intended to convey the impression that the work 
 of some of the authors of the "Systems " was valueless from the point 
 of view of physiology and chemistry, for Stahl, von Helmont, and 
 Sylvius were pioneers in these subjects. It is medicine only that is re- 
 ferred to in the above passage.
 
 DURING THE REIGN OF GEORGE III 7 
 
 that much of the inability of thinkers to advance, and 
 many of the misconceptions that had arisen concerning 
 the fundamental principles of life were largely due to 
 the particular teaching then in vogue. They pointed 
 out that a system of teaching which directed mental 
 activities to the fixed and the past was not conducive 
 to an intellectual training for the purpose of advancing 
 on new and, therefore, untrodden paths of thought. If 
 this be true, there can be no doubt that physicians, 
 during the early years of the reign of George III, lacked, 
 as a rule, that particular kind of training, for they were 
 largely under the influence of this special form of 
 teaching. In many of them erudition in classical attain- 
 ments far outweighed their eminence in medicine and 
 formed, indeed, their chief claim to distinction. Their 
 special mental training encouraged them to place more 
 reliance upon speculative theorising concerning disease 
 than upon the meaning of facts and conditions observed 
 at the bedside and on the post-mortem table. 
 
 But a change for the better was close at hand. Early 
 in the reign of George III the work of Morgagni began 
 to produce an effect upon medical thought in England, 
 and soon many physicians were engaged in obtaining a 
 real knowledge of disease from the study of morbid con- 
 ditions found after death. The logical consequence of 
 the work of Morgagni found expression in the labours of 
 Baillie and Bichat, both of whom carried the subject 
 forward. These prominent men were the real fathers 
 of modern pathology and medicine. They occupied 
 positions similar to those of Voltaire and Montesquieu 
 in thought, Burke in politics, and Newton in natural 
 philosophy. They were bold innovators who swept 
 away an ancient order of things which had long cum- 
 bered the ground, and defied advance. They established, 
 on lines never since departed from, the only rational 
 study of disease. Our debt to them can scarcely be ex- 
 pressed in words.
 
 8 MEDICINE IN ENGLAND 
 
 THE CONDITION OF THE MEDICAL PROFESSION 
 
 Having thus summarised the general state of medical 
 thought as it existed at the beginning of the reign of 
 George III, it now becomes necessary to study the more 
 intimate conditions found in the medical profession at 
 that time. 
 
 During the reign the medical profession was divided 
 into three grades : physicians, surgeons, and apothe- 
 caries. In London, and for seven miles around, these 
 three divisions were governed respectively by the 
 College of Physicians, the Corporation of Surgeons, and 
 the Society of Apothecaries. But beyond this area none 
 of these bodies exercised any very effective control 
 over its members and its privileges. It came to pass, 
 therefore, that many practitioners resided in the 
 provinces who owed no allegiance to those bodies, and 
 often possessed no legal title to practise either medicine 
 or surgery. 
 
 It is difficult to arrive at any correct estimate of the 
 actual numbers of practitioners in England at this time, 
 for although the registers of the three licensing bodies 
 can be consulted, they contain a small proportion only 
 of the total. There is, however, one important source 
 of information from which a fairly accurate estimate of 
 the numbers engaged in practice can be obtained. In 
 1779 Dr. Samuel Foart Simmons, physician to St. Luke's 
 Hospital, published a Medical Register. 1 This was the 
 first attempt to gather into one volume particulars of 
 the medical profession and its activities. Unfortun- 
 ately only three issues were made, but in the last, which 
 appeared in 1783, data are found from which an estimate 
 of the numerical strength of practitioners resident in 
 England can be calculated. From an investigation of 
 this invaluable book, only a few copies of which are 
 known to exist in London, it is found that in 1782, 
 
 1 "The Medical Register," 1779-80-83.
 
 DURING THE REIGN OF GEORGE III 9 
 
 4459 medical men were resident in England and Wales, 
 to serve a population estimated at 7,814,827 souls, or 
 one medical man for every 1752 people. Of this number, 
 774 doctors were resident in London, with an estimated 
 population of 650,845, or one medical man to every 840 
 inhabitants. The subject of overcrowding in the medical 
 profession has been ventilated frequently of late years, 
 but when the ratios just given are compared with those 
 obtaining at the present day no very marked difference 
 will be found. At the present time about 25,000 prac- 
 titioners in England and Wales serve a population of 
 about 36,000,000, or one to every 1440 people, while in 
 London about 6500 doctors attend about 4,500,000 
 people, or one to every 705 inhabitants. The author of 
 "A Picture of the College of Physicians" 1 estimated 
 that in 1817 London, with a population of 1,100,000, 
 had in residence 1098 doctors, or one to every 1000 
 people. Nor can it be said that the scale of remuneration 
 for medical services has altered to any considerable 
 extent. Physicians in those days charged a guinea, 
 at a time when the purchasing power of the sovereign 
 was far greater than it is now. Indeed, it may be stated 
 with safety that a relatively larger number of physicians 
 secured a handsome competence from the practice of 
 medicine in the reign of George III than is the case at 
 the present day, while some, such as Lettsom, Warren, 
 Simmons, and Battie realised large fortunes. 
 
 According to the " Medical Register " for 1783 
 London contained 149 physicians, 274 surgeons, and 
 351 apothecaries. This return, however, takes no 
 account of many who, owing to the laxness of super- 
 vision, sold drugs and practised surreptitiously without 
 any proper authorisation, and the same remark applies 
 with greater force to the provinces. The College, jointly 
 with the Master and Wardens of the Society of Apothe- 
 caries, had the power of supervision over drugs sold by 
 1 " A Picture of the Royal College of Physicians," 1817.
 
 10 MEDICINE IN ENGLAND 
 
 apothecaries, but towards the latter part of the eigh- 
 teenth century a new order had arisen which, as will be 
 seen, made it necessary to recast the laws and regula- 
 tions governing the apothecaries. This new order was 
 the druggists, and over these neither the College of 
 Physicians nor the Society of Apothecaries possessed 
 any jurisdiction. 
 
 An investigation of the composition of the College 
 of Physicians, and of the parts of London favoured by 
 those belonging to it during this reign, is of considerable 
 interest. In 1746 the College was composed of 54 
 Fellows and 24 Licentiates. Of these 47 resided in the 
 City and 14 in the West End. 1 In 1782 there were 43 
 Fellows and 74 Licentiates, of whom 35 lived in the 
 City and 42 in the West. 2 The migration from the City 
 to the West had now begun to be marked, and in 1817, 
 out of 89 Fellows and 224 Licentiates, 32 only lived in 
 the City, while 105 practised in the West. 3 From this 
 time the exodus from the City progressed steadily, until 
 at the present day two Fellows only remain to uphold 
 the honour of the College in the heart of the greatest 
 city in the world. 
 
 An examination of the number of Fellows and Licen- 
 tiates admitted is also instructive. From 1760 to 1820 
 inclusive, 128 Fellows were created, or an average of 
 2.1 per annum, and during the same period 416 Licenti- 
 ates were admitted, or an average of 6.9 per annum. 
 During the last thirty years of the reign the influx of 
 Licentiates became pronounced, and at the end of the 
 reign they outnumbered the Fellows in a proportion of 
 nearly three to one. 4 This influx of Licentiates must be 
 
 1 See " An Address to the College," 1747. 
 
 8 See " The Medical Register," 1783. 
 
 8 "A Picture of the College," 1817. 
 
 4 The above calculation has been made from Munk's "Roll of the 
 College of Physicians." It should be remembered that the Licentiates 
 in the days of George III did not correspond to those holding the same 
 diploma at the present day, but rather to the Members of the College of 
 our times.
 
 DURING THE REIGN OF GEORGE III 11 
 
 attributed to the rising influence of the Edinburgh 
 school, which was nearing its zenith. A large number 
 of men were taught in Edinburgh, and those who came 
 to seek their fortune in England were obliged, by the 
 laws in force regarding physicians, to become Licentiates 
 of the College. 
 
 MEDICAL LAWS AND REGULATIONS 
 
 Attention must now be paid to a consideration of the 
 laws and regulations under which the medical profession 
 worked at this period. No central authority possessing 
 powers under Parliamentary Acts existed, but the three 
 corporate bodies of the College of Physicians, the Cor- 
 poration of Surgeons, and the Society of Apothecaries 
 respectively exercised jurisdiction over physicians, the 
 surgeons, and the apothecaries. But even then the 
 power to assert authority by these bodies was limited 
 and often exhibited in a lax manner. As might be 
 supposed, their charters, granted in a bygone age, were 
 ill-adapted to new and constantly changing conditions. 
 They referred rather to the profession resident in London, 
 and contained no strict provisions for the control of 
 those of their members who resided in the provinces. 
 The College of Physicians possessed ample authority 
 over all physicians engaged in practice in London, and 
 no physician could pursue his vocation in the metropolis 
 and seven miles around without a licence from the 
 College, after having been duly examined. Further, 
 by the first Statute (14 & 15 Henry VIII, c. 5) which 
 confirmed the original Charter, the College was given 
 power to examine and grant licences to all physicians 
 in England, with the important exceptions of graduates 
 in medicine of Oxford and Cambridge. Over them it 
 had no jurisdiction so long as they practised in the 
 provinces. Previous to the granting of the first 
 Charter of the College, the right had been conceded 
 to the Bishop of London and the Dean of St. Paul's,
 
 12 MEDICINE IN ENGLAND 
 
 with the assistance of physicians and surgeons, to 
 examine and grant licences to those wishing to engage 
 in practice. The same right was also given to a 
 Bishop or his Vicar-General in the provinces. Even 
 so late as 1687 some Bishops continued to exercise 
 this right, and the practice was not given up until 
 the College had issued a warning on the subject to 
 each Bishop. In addition to its other powers, the 
 College was possessed of the right of entering apothe- 
 caries' shops in order to inspect the drugs offered for 
 sale. 
 
 In much the same way the Corporation of Surgeons 
 and the Society of Apothecaries exercised jurisdiction 
 over members of their bodies, but the control was far 
 less efficient than that of the College. In London it 
 might be described as fairly effective, but in the pro- 
 vinces it left much to be desired. This failure of control, 
 especially so far as it regarded the Society of Apothe- 
 caries, was due to the fact that it had no authority 
 over those who were not members of the Society. 
 Consequently a large body of practitioners came into 
 existence, and soon caused considerable alarm. These 
 men were not members of any legally constituted body, 
 they held no diploma entitling them to practise medicine 
 and surgery, but, notwithstanding, they carried on 
 their business without let or hindrance. Soon they 
 formed the majority of the medical profession, but no 
 power existed by which they could be brought under 
 proper control. In London these buccaneers of the 
 profession could be dealt with in an effective manner, 
 but not so in the provinces. According to John Mason 
 Good, these men were merely druggists who, in addi- 
 tion to selling drugs, compounded and dispensed 
 medicines and practised medicine and surgery. They 
 sold pure drugs to the apothecary, but reserved the 
 impure drugs for their own use. They were unversed 
 in Latin, and could not, therefore, read prescrip-
 
 DURING THE REIGN OF GEORGE III 13 
 
 tions. 1 They first made their appearance towards the end 
 of the seventeenth century, and, by the end of the eigh- 
 teenth century, they had become so numerous that it was 
 felt on all sides that something should be attempted to 
 bring them under some sort of control. 
 
 The result of this incursion of unqualified and ignorant 
 men into the medical profession was the passing of the 
 Apothecaries Act in 1815, but before this could be 
 accomplished public opinion had to be roused concern- 
 ing the danger. In this agitation for a better state of 
 things the names of John Mason Good and George Man 
 Burrows stand out prominently, and it was owing 
 entirely to their powerful advocacy that the reform was 
 brought about. The former founded the " Pharma- 
 ceutic Association " in 1794, while the latter was re- 
 sponsible for the " Association of Surgeon Apothecaries," 
 both societies being devoted to the improvement of the 
 position of that branch of the profession. If they 
 received no encouragement, at least they met with no 
 active opposition, from the Colleges of Physicians and 
 Surgeons, and soon the labours of the two Associations 
 bore fruit. On August 1st, 1815, the " Apothecaries 
 Act " became law, and for the first time in the history 
 of medicine in this country, cognisance was taken] of 
 the principle that all those who practised must first be 
 properly qualified. 
 
 By the provisions of the '^Apothecaries; Act," all 
 those who kept an apothecary's shop were required to 
 pass an examination before examiners appointed by the 
 Society of Apothecaries, and all candidates for the 
 examination were required to give proof of having served 
 five years as apprentices . The Master and Wardens of the 
 Society were empowered to enter any apothecary's shop 
 in England and Wales and to impose fines if impure drugs 
 
 1 For a full account of this movement see " History of Medicine so 
 far as it relates to the Apothecary," John Mason Good, 1798, and various 
 tracts by G. M. Burrows.
 
 14 MEDICINE IN ENGLAND 
 
 were found. Finally, no apothecary could recover debts 
 in a court of law unless he possessed a licence to practise. 1 
 There can be no doubt that the passing of this Act 
 marked an immense advance in the regulations for the 
 control of the profession, and it was the forerunner of 
 all subsequent Acts. It had, however, its defects, and 
 it would have been well had the two Colleges enquired 
 more closely regarding the consequences of this Act. 
 What was its effect ? At a stroke the education of 
 about three-fourths of those who contemplated entering 
 the medical profession was placed under the entire 
 control of the Society of Apothecaries through legal 
 powers granted by Parliament. The Colleges had no 
 voice in the matter of determining the scope of medical 
 education, and could deal only with those belonging to 
 their own bodies. It must be admitted that their policy 
 was somewhat short-sighted, for it would have been a 
 comparatively easy matter to adjust their relations with 
 the Society of Apothecaries in such a manner that a 
 share of the control conferred by Parliament would 
 have fallen to their lot. As it was, the Colleges were 
 shut out from all participation in the control of the 
 education of the greater number of the profession, 
 and many years had to elapse before they regained their 
 power. 
 
 MEDICAL EDUCATION 
 
 Consideration may now be given to the facilities ex- 
 isting for the acquirement of medical knowledge during 
 this period, and to the standard deemed necessary. At 
 this time the three capitals of the British Isles were the 
 only centres at which medical education could be 
 obtained, and, so far as regards the number of students, 
 London and Edinburgh were far in advance of Dublin. 
 In London seven general hospitals were established 
 where a knowledge of medicine could be obtained. At 
 
 1 For the detailed provisions of the "Apothecaries Act" see "The 
 Statutes," 55 George III C. 194-, and " Parliamentary History," 1815.
 
 DURING THE REIGN OF GEORGE III 15 
 
 Guy's, St. Thomas's, and the London hospitals, system- 
 atic courses of lectures in the Theory of Medicine, 
 Materia Medica, Chemistry, and Clinical Medicine were 
 given, but in most of the other hospitals the teaching 
 was sadly neglected. Too often the members of the 
 medical and surgical staffs considered it to be no part 
 of their duty to give instruction except to a few favoured 
 pupils from whom they exacted a premium for the 
 privilege. 
 
 As a rule, the subjects of Medicine, Materia Medica, 
 Anatomy, and Chemistry were taught at schools and 
 lectures supported by private enterprise, of which there 
 were many in the metropolis at this time. In the 
 *' Medical Register " for 1783 1 a page is devoted to a 
 list of lectures, and of the nineteen given there all were 
 supported by private enterprise with the exceptions of 
 those at the London, St. Thomas's, and Guy's Hospitals. 
 Indeed, it appears that Dr. George Fordyce of St. 
 Thomas's, Dr. William Saunders of Guy's, and Dr. 
 James Maddox of the London, were the only physicians 
 who gave systematic courses of lectures at the institu- 
 tions to which they were attached. In the same manner 
 the subject of midwifery was taught by means of private 
 lectures given by Denman, Osborne, Orme, John Clarke, 
 and David Davis. Prominent among these private 
 lecturers was Dr. George Fordyce, who lectured for 
 thirty years on Physic, Materia Medica, and Chemistry 
 at his house in Essex Street, Strand. He was assiduous 
 and unremitting in his work ; beginning at seven in the 
 morning, he delivered three lectures, each lasting an 
 hour, on six days in the week, and probably nearly all 
 the students coming to London at this period passed 
 through his hands. 2 The teaching of Anatomy was 
 
 1 See the "Medical Register" 1783, and the Appendix to this 
 volume. 
 
 2 For an excellent memoir of Dr. George Fordyce see the " Gentle- 
 man's Magazine," June, 1802, from the pen of his friend and colleague 
 Dr. W. C. Wells.
 
 16 MEDICINE IN ENGLAND 
 
 carried on chiefly at the school in Windmill Street, 
 where the brilliant abilities of the two Hunters, Hewson, 
 Cruikshank, Baillie, and Wilson made it deservedly 
 famous. Mr. John Shelden, Dr. R. Maclaurin, and Mr. 
 Blizzard also taught Anatomy at their respective 
 houses with considerable success. 
 
 After a student had attended lectures and the prac- 
 tice of a hospital for a sufficient length of time, which 
 varied at different periods, he was free to present 
 himself for examination at the Corporation of Surgeons, 
 or the Society of .Apothecaries, and if he satisfied the 
 examiners he was granted a diploma. Often, however, 
 he did not follow this course, but after studying medi- 
 cine and surgery betook himself to the provinces and 
 began practice without any diploma. He was quite 
 secure, and no law could reach him so long as he re- 
 mained away from London. 
 
 When, however, a student decided to practise as a 
 physician the course to be pursued was different and 
 far more exacting. It was necessary for him to obtain 
 a degree in some University, and, in due time, to 
 submit himself to the examination for Licentiates at 
 the College of Physicians. This course was obligatory 
 for all physicians, with the exception of those engaged 
 in practice in the provinces who were in possession of 
 the M.D. degree of either Oxford or Cambridge. The 
 holders of these degrees were exempted by statute from 
 being obliged to become Licentiates so long as they 
 practised in the provinces. But the College of Physicians 
 exercised no very strict supervision over physicians 
 beyond the London area, and many were actively 
 engaged in practice who were not in possession of the 
 M.D. degree of either Oxford or Cambridge. From all 
 accounts, the examination for the Licence of the College, 
 which was conducted in Latin, was thorough and search- 
 ing. It not only established the fact that a successful 
 candidate was learned in the principles of medicine, but
 
 DURING THE REIGN OF GEORGE III 17 
 
 it proved also that he was a man of considerable erudi- 
 tion and culture. The examination for the Candidates 
 for the Fellowship was precisely the same as that for 
 the Licentiate, and the College could justly claim that 
 the members of their body were men of far higher 
 mental attainments than those of the Corporation ot 
 Surgeons, and the Society of Apothecaries. 
 
 At the Universities of Oxford and Cambridge the 
 Professors of Physic and Anatomy delivered courses 
 of lectures, and so also did the Professors or Readers 
 of Botany and Chemistry, but the reading of these 
 lectures appears to have been of a somewhat perfunctory 
 nature, and no practical instruction appears to have 
 been given. Those who intended, therefore, to become 
 physicians settled at centres where the serious study of 
 medicine could be prosecuted, and, except for the 
 purpose of fulfilling the requirements of the Univer- 
 sities in the matter of a medical degree, were hardly 
 ever in residence. During the early years of the reign, 
 London, Edinburgh, Dublin, and Aberdeen were the 
 only places in this country where a medical education 
 could be acquired, and none of them enjoyed a reputa- 
 tion sufficient to attract a large number of those who 
 proposed to become physicians. Many, therefore, pro- 
 ceeded to the various schools on the Continent, and it 
 was only in the latter years of the reign that the ex- 
 cellence of the medical teaching in London, and especially 
 in Edinburgh, attracted large numbers of those who 
 desired to perfect themselves in the art of medicine. 
 
 At the sister Universities the regulations relating to 
 medical degrees differed, and are, indeed, difficult to 
 follow with any exactness. According to the author 
 of " An address to the College," 1 the method of pro- 
 cedure in granting medical degrees at Oxford was as 
 follows. No person could be admitted to the honour 
 
 1 See "An Address to the College," 1747, pp. 7-9. This account 
 appears to be the most accurate, and has, therefore, been adopted.
 
 18 MEDICINE IN ENGLAND 
 
 of a doctor's degree in medicine until he had been a 
 member of the University for fourteen years, and had 
 complied with all the exercises required. In other 
 words, he was expected to become a Bachelor of Arts 
 in four years, a Master in seven years, a Bachelor of 
 Medicine in ten years, and a Doctor in fourteen years. 
 The principle, therefore, of a degree in arts before pro- 
 ceeding to one in medicine was established. For the 
 B.A. degree candidates were required to defend ques- 
 tions in logic, grammar, rhetoric, and moral philosophy ; 
 to be examined in the same subjects, and all the exami- 
 nations and exercises were conducted in Latin. For 
 the M.A. degree the candidate was again required to 
 defend questions in the subjects for the B.A., and, in 
 addition, questions in Natural and Moral Philosophy. 
 Lastly, he was required to pass an examination in 
 Geometry, Metaphysics, Optics, Physics, History, Geo- 
 graphy, Chronology, Latin, and Greek. At Cambridge 
 the exercises for the same degree appear to have been 
 similar, but perhaps more latitude was allowed to 
 candidates in specialising in particular subjects. Now, 
 whatever may have been the way in which these exer- 
 cises were kept in the letter, and many asserted that 
 they were a mere farce, there can be no doubt that in 
 the spirit they contained the framework of a compre- 
 hensive intellectual training. Indeed, those who relied 
 on the system at the two Universities as the best pre- 
 liminary course for those intending to become phy- 
 sicians could point with truth to the regulations in 
 force to prove their argument. For the M.B. degree 
 the candidate was expected to defend two subjects in 
 physic for two hours, and to oppose two others for a 
 like period. In 1760, according to Dr. Wells, the Act 
 for the degree of Bachelor of Medicine consisted of 
 reading the Aphorisms of Hippocrates. 1 However that 
 may be, the candidate was obliged to go through a 
 
 1 See "A Letter to Lord Kenyon," p. 109 note. Wells.
 
 DURING THE REIGN OF GEORGE III 19 
 
 course of anatomy before proceeding to keep the Act, 
 For the M.D. degree the candidate was required to 
 explain a whole book of Galen in six extempore or 
 three written lectures. 
 
 At Cambridge perhaps a somewhat more pronounced 
 attempt was made to impart medical knowledge by 
 means of lectures, and some of the professors appear to 
 have performed their functions with some little show 
 of energy. The degree of Bachelor of Medicine could be 
 taken six years after admission, provided that the 
 candidate had kept nine terms at the University. Two 
 public disputes had to be maintained in Latin by the 
 candidate. One question was chosen by the candidate 
 and the other by the professor. The candidate then 
 read a thesis on his own question, and defended it and 
 the professor's question against the arguments of the 
 professor and other doctors present. Finally, the pro- 
 fessor read his " Determination " in Latin. This pro- 
 ceeding was conducted in the public schools, and, as a 
 rule, many spectators were present. 1 The degree of 
 M.D. could be taken five years after the M.B. degree, 
 and the exercises required were on the same lines as 
 those for the M.B. Dr. Wells states that originally the 
 candidate was obliged to oppose another candidate, but 
 that this regulation was abrogated on the payment of a 
 fine of twenty shillings. He also asserted that the 
 professor's question could be obtained by the candidate 
 at any time, however long, before the Act was kept. 2 
 At Cambridge and Oxford a doctor's degree in medicine 
 was sometimes given by " Royal Mandate," and ap- 
 parently it was not always obligatory to proceed in 
 Arts before taking the M.B. degree, although this course 
 was generally pursued. Besides the degrees of M.B. 
 and M.D. the Universities granted a " Licence to 
 Practise." Professor Haviland, however, in his evi- 
 
 1 See "The Medical Register," 1780. 
 
 2 See " A Letter to Lord Kenyon," p. 109 note. Wells.
 
 20 MEDICINE IN ENGLAND 
 
 dence before the Select Committee of the House of 
 Commons in 1834, stated that few took the " Licence to 
 Practise." He also stated that the examination was 
 more practical than that for the M.B., and that, since 
 the possession of the M.B. degree sometimes disqualified 
 from holding a Fellowship, the " Licence to Practise " 
 was taken in preference. 1 The foregoing then is a 
 picture of the course of education followed by many of 
 those who desired to become physicians. The tendency 
 of that education was in the direction of general culture, 
 and accounts for the high order of intellectual capacity 
 which was such a prominent feature of the College of 
 Physicians in those days. 
 
 In other Universities the same spirit prevailed, but 
 in many of them the insistence on the acquirement of 
 general knowledge was far less pronounced, and more 
 facilities were afforded for becoming versed in the 
 principles and practice of medicine. Especially was 
 this the case at Edinburgh and Leyden, whither many 
 physicians during the reign repaired for the purpose of 
 undertaking the serious study of medicine. 
 
 HOSPITALS AND DISPENSARIES 
 
 In close association with the facilities for the ac- 
 quirement of medical knowledge was the rise and 
 development of the hospitals and dispensaries in London 
 and the provinces ; truly one of the most remarkable 
 features in the medical history of the reign. When 
 George III ascended the throne in 1760, London 
 possessed seven general hospitals, two asylums, and six 
 special hospitals, but not a single dispensary. So far 
 back as 1696 an attempt had been made by the College 
 of Physicians to establish a dispensary for the benefit 
 of those who were too poor to purchase pure drugs, 
 
 1 See Haviland's evidence before the Select Committee of the House 
 of Commons, appointed to enquire concerning Medical Education. 
 " Parliamentary Papers," 1834, pp. 243-263:
 
 DURING THE REIGN OF GEORGE III 21 
 
 but after a time the project fell into abeyance. 1 With 
 that exception no dispensary existed in the metropolis 
 until 1770, when the General Dispensary in Aldersgate 7 
 Street was founded. This was followed by the West- r 
 minster Dispensary in 1774, and between that date and 
 the close of the reign in 1820 no less than thirty-four 
 dispensaries and three hospitals came into being, of 
 which eighteen remain in active work at the present 
 day. 
 
 In the provinces the same conditions prevailed. 
 Before 1760 sixteen hospitals and one asylum repre- 
 sented all the public institutions in existence for the 
 treatment of the sick poor. But during the reign no 
 less than forty-five hospitals, thirty-six dispensaries, 
 and eight asylums were founded in various parts of 
 England, with the result that accommodation for the 
 treatment of disease amongst the poor became ample. 2 
 
 The need for increased facilities for the medical 
 treatment of the poor of growing England, and the 
 wider conceptions in vogue concerning the duties of 
 the rich towards the poor, no doubt were largely re- 
 sponsible for the foundation of the hospitals and dis- 
 pensaries. Many of these institutions, however, owed 
 their origin to the insistent demands of energetic 
 physicians, who, supported by their influential friends, 
 desired a field for clinical work. At that time, physicians 
 of great ability were beginning to flock to England, 
 especially from the rising school of Edinburgh. The 
 possibilities of obtaining positions where they could 
 found professional reputations as teachers were few, 
 and the staffs of existing hospitals were limited and 
 
 1 In this connection mention should be made of Garth's poem "The 
 Dispensary," in which the characters and peculiarities of many of the 
 Fellows of the College of that day are painted with much wit and 
 humour. 
 
 2 For further information concerning dispensaries see " Laws and 
 Plans of Dispensaries," 1765-1811, and "History Design, and Present 
 State of Public Charities." A. Highmore, 1810.
 
 22 MEDICINE IN ENGLAND 
 
 exclusive. In this difficulty the more enterprising 
 spirits threw themselves with ardour into the project, 
 and so it came to pass that the new hospitals and dis- 
 pensaries were staffed by some of the ablest and most 
 enlightened physicians in the country. The names of 
 Fothergill, Lettsom, James Sims, Hulme, Johnston, 
 Simmons, Wells, and Willan are prominently con- 
 nected with this movement, and some of the dispen- 
 saries in London, such as the " General," the " West- 
 minster," and the " Public," soon became centres for 
 teaching, and the excellence of the clinical instruction 
 attracted many students. A particular interest attaches 
 to the " Public Dispensary " in Carey Street, for it 
 was there that Robert Willan and his pupil Thomas 
 Bateman prosecuted their researches in Dermatology, 
 and gave to the world the first attempt to classify skin 
 diseases from an anatomical standpoint. 
 
 Further evidence of medical activity in this reign is 
 found in the rise of the numerous societies devoted to 
 the advancement of medicine. Probably the earliest 
 society of this kind of which we have any record was 
 one founded by Glisson about 1650, and mentioned in 
 his work on Rickets. The next was the Society of 
 Naval Surgeons, which began its career in 1746. This 
 society engaged Mr. Sharp to deliver lectures on surgical 
 operations, and met at a house in Covent Garden. 
 Sharp was soon succeeded by William Hunter, who 
 continued the course for several years. In 1752 a 
 Medical Society of Physicians was founded, chiefly 
 owing to the energy of Fothergill, and met at the Mitre 
 Tavern. The next to be formed was the " Society of 
 Licentiate Physicians " in 1764 by Fothergill and 
 Alexander Russell. Licentiates of the College only were 
 eligible for election, and the meetings were held at 
 " Old Slaughter's Coffee House," but once a quarter the 
 members dined at the " Crown and Anchor." In 1767, 
 at the instigation of Dr. Heberden, the " Meetings of the
 
 DURING THE REIGN OF GEORGE III 23 
 
 College of Physicians " were begun, and between that 
 date and 1820 six volumes of transactions were issued. 
 1771 saw the foundation of the " Guy's Physical Society" 
 by Dr. William Saunders, and the same year witnessed 
 the establishment of the Physico-Medical Society. The 
 Medical Society was founded in 1773, and in the follow- 
 ing year the " Middlesex Hospital Society " began its 
 career. Mr. John Shelden formed a Medical Society in 
 1779, which met at his house in Great Queen Street, 
 and in 1762, owing to the efforts of Dr. Simmons, Dr. 
 Fordyce, and John Hunter, the Society for the Im- 
 provement of Medical Knowledge was established, the 
 meetings being held at " Old Slaughter's Coffee House." 
 Fordyce was also responsible for the foundation of the 
 " Lyceum Medicis Londinense " in 1785. Finally, the 
 " Medical and Philosophical Society of St. Bartholo- 
 mew's," renamed in 1832 the " Abernethian," x was 
 formed in 1795, the " Medico-Chirurgical " in 1805, and 
 the " Hunterian " in 1819. A Society of Physicians to 
 Dispensaries met in the Borough about 1780, but the 
 exact date of its foundation is uncertain. 2 
 
 It will thus be seen that twelve medical societies 
 were formed during the reign of George III, and three 
 only before that period. Many of them came to an end 
 after a few years of usefulness, but six remain and are 
 flourishing at the present time. Among those who did 
 so much to encourage the formation of these London 
 medical societies the names of Fothergill, Simmons, 
 Lettsom, Fordyce, and William Hunter must be for " 
 ever honoured. They toiled, not unsuccessfully, for the 
 advancement of medicine, and for a wider medical polity 
 where men holding diverse opinions could meet and 
 exchange their views. 
 
 1 For an account of the "Abernethian " Society, see St. Bart's Hosp. 
 Reports, Vol. IV, by Dr. Rowland Combs. 
 
 3 This statement rests on the authority of Leonard Gillespie, whose 
 diary will be found in the " Admiralty Medical Journals," Admiralty 
 Series, Public Record Office.
 
 24 MEDICINE IN ENGLAND 
 
 In the provinces also three medical societies were 
 formed during the reign. The first one being the 
 Colchester Medical Society in 1774. This was followed 
 by the Plymouth Medical Society in 1794, and the 
 Leicester Medical Society in 1800, but previous to the 
 formation of these three societies there is no record to 
 be found of any similar society existing in the provinces. 
 To complete the review of the establishment of medical 
 societies, it remains to be said that towards the end of 
 the eighteenth century six medical benevolent societies 
 were founded in the provinces and one in London, all of 
 which are flourishing at the present day. 1 
 
 THE ROYAL COLLEGE OF PHYSICIANS 
 
 The position of the College of Physicians with regard 
 to medical progress must now claim attention. This 
 enquiry embraces the history of the great contest be- 
 tween the Fellows and the Licentiates ; it also involves 
 an investigation of the powers conferred by Charter 
 upon the College and the spirit in which they were 
 applied. 
 
 The great contest in the College between the Fellows 
 and the Licentiates definitely began in 1752, although 
 the first mutterings of the coming storm were heard as 
 far back as 1746. From that date it dragged on its 
 weary length for more than eighty years, sometimes 
 waxing and sometimes waning, but never really ceasing. 
 Small advances occupied decades for their attainment, 
 and it was not until the beginning of the reign of Queen 
 Victoria that the College could see its way to concede 
 the main great principle for which the Licentiates had 
 contended. For a long time the College was apparently 
 
 1 Much of the information concerning the history of the medical 
 societies will be found. in the "Medical Register," 1789-93. See also 
 "Hunterian Oration" by Dr. Newton Pitt, "Lancet," 1896, Vol. I, and 
 Mr. D'Arcy Power's Account. I have also to acknowledge my in- 
 debtedness to Dr. Clippingdale, who has allowed me to read his invalu- 
 able MSS. dealing with that subject.
 
 DURING THE REIGN OF GEORGE III 25 
 
 content to accept the existing order of things, and 
 appeared little disposed to move in the direction of any 
 change. Some of the Licentiates, however, were active 
 in their efforts for what they held to be a salutary 
 reform. Amongst these reformers may be mentioned 
 the names of Fothergill, Archer, Wells, Ferris, and 
 Stanger, and no small part of the advancement made 
 in medico-political spheres was due to the persistent 
 advocacy of these men. In season and, it must also be 
 admitted, often out of season, they urged upon the 
 College the necessity for reform. To their unwearied 
 perseverance we owe it that the College now rests on the 
 sure foundations of justice and liberality towards the 
 three estates over which it exercises jurisdiction. 
 
 What was this contest between the Fellows and the 
 Licentiates ? It arose in this way. The Charter of the 
 incorporation of the College, and the Statutes of 14 and 
 15, Henry VIII, gave the whole control over the practice 
 of physic into the hands of the College with the excep- 
 tion that Doctors of Medicine of Oxford and Cambridge 
 might practice in the provinces free from that control. 
 In 1555 the College saw fit to pass a bye-law limiting the 
 number of its Fellows, and at the same time instituted 
 the grade of Licentiates. In addition to these enact- 
 ments, the practice had grown up in the College of 
 electing to the Fellowship only those who possessed 
 the degree of Doctor of Medicine from the Universities 
 of Oxford and Cambridge. It is not very clear when 
 the bye-law embodying this principle was put into 
 operation, but is was probably not before 1575. By 
 this practice, therefore, which became the established 
 rule of the College, the whole of its government was 
 placed in the hands of those who were Doctors of 
 Medicine of Oxford and Cambridge/ and Doctors of 
 Medicine of other Universities, unless they could 
 become incorporated with Oxford or Cambridge, were 
 relegated to the grade of Licentiates, without any
 
 26 MEDICINE IN ENGLAND 
 
 prospect of ever becoming Fellows, or of having any 
 voice in the government of the College. The exami- 
 nation at the College for a Licentiate was precisely the 
 same as that for a Candidate for the Fellowship. Out- 
 side the walls of the College the Licentiate enjoyed the 
 same privileges and distinction as a Fellow, but within 
 the College he was beneath them. This was the position 
 which gave rise to the contest between the Fellows and 
 the Licentiates. Holding that they were the equals of 
 the Fellows, in that they had performed the same 
 exercises, they claimed that they should be admitted 
 to the examination for the Candidates for the Fellow- 
 ship with its rights and privileges. 
 
 The contest really began with the demand of Isaac 
 Schomberg to be admitted to the examination for the 
 Candidates for the Fellowship. Schomberg had, in 
 defiance of the Statutes, practised in London as a 
 physician, and was summoned in 1746 by the Censors' 
 Board to present himself for the examination for the 
 Licentiates. This he refused to do, but in 1747, having 
 been entered at Trinity College, Cambridge, he asked to 
 be allowed to practise until he should obtain the M.D. 
 degree. This the College refused, and interdicted him 
 from practice until he -had given satisfaction. In 1749 
 Schomberg obtained the M.D. degree by Royal Mandate, 
 and then applied to be examined, but the College 
 refused this until such time that the interdiction was 
 removed. He then offered an apology which was 
 accepted by some but not by all. In 1750 he demanded 
 to be examined for the Candidate for the Fellowship in 
 virtue of his M.D. degree. He was allowed to sit, and 
 was adjudged competent, but this decision was nega- 
 tived by a majority, and he was refused admission. 
 Schomberg then took his case to the Law Courts, but 
 met with no success, the Court holding that the College 
 had full power to do as they thought fit. However, in 
 1765 he was admitted a Licentiate, and in 1771 a Fellow.
 
 DURING THE REIGN OF GEORGE III 27 
 
 He even attained to the dignity of being a Censor in 
 1773 and 1778. J This case called forth Sir William 
 Browne's " Vindication of the College," which he in- 
 tended to read as a reply to the contentions of Schomberg 
 had the " Visitors " decided to hear the case. It is per- 
 haps fortunate that no such occasion arose for reading this 
 piece, for it is the most vain and pedantic effusion that 
 ever proceeded from the pen of that singular personality. 2 
 
 After this, three acts performed by the College con- 
 tributed largely to the accentuation of the differences 
 between the Fellows and the Licentiates. They were as 
 follows : 
 
 1. Subsequent to the year 1752 the practice of sum- 
 moning the Licentiates to the College meetings was 
 abandoned. 2. The College passed in 1752 the 
 " Statutum Alterum de Candidatis," in which it was 
 stated in unmistakable language that no person could 
 become a Fellow unless he held the degree of Doctor 
 of Medicine of either Oxford or Cambridge. 3. In 1765 
 the Statutes and Bye-Laws of the College, after having 
 been revised, were printed for the use of the College 
 officers, thus rendering them available for the purposes 
 of investigation. 
 
 These acts, but particularly the " Statutum Alterum 
 de Candidatis," were the cause of the recrudescence of 
 the controversy in 1765. Two parties were formed. 
 The Licentiates maintained that there were many 
 belonging to their body who, although they possessed 
 no Doctorate degree from the sister Universities, were 
 nevertheless thoroughly fitted by education and medical 
 attainments to adorn the Fellowship of the College. 
 On the other hand, the thick and thin supporters of 
 the existing order were convinced that no man who had 
 not been educated at either Oxford or Cambridge 
 
 1 For the Case of Schomberg, see ' ' Minutes of the Proceedings Rela- 
 ting to Dr. Schomberg," 1754. 
 
 51 ' A Vindication of the College." Sir W. Browne, 1753.
 
 28 MEDICINE IN ENGLAND 
 
 could be worthy of the honour of the Fellowship. The 
 Licentiates held that the action of the College in ex- 
 cluding them was contrary to the spirit of the Statutes 
 in virtue of which the College exercised authority and 
 jurisdiction. They pointed out that anyone holding a 
 degree in medicine from a foreign University could 
 become incorporated at either Oxford or Cambridge on 
 that degree, and could in that way gain admission to the 
 Fellowship. They also urged that the curriculum at 
 Oxford and Cambridge scarcely existed for medical 
 students ; that the study of medicine in the sister 
 Universities was a farce which could be performed in 
 four years by anyone holding an M.A. degree, at the 
 expense of attending a few lectures. This, no doubt, 
 was true with regard to the teaching of medicine, but it 
 must be remembered that both Oxford and Cambridge 
 offered considerable facilities for the acquirement of a 
 wide culture. All those intending to study medicine 
 were obliged to graduate in Arts, and the scope of the 
 course instituted for the degrees of Bachelor and Master 
 of Arts has already been described. 
 
 To all these contentions of the Licentiates the College 
 turned a deaf ear. They asserted that they knew the 
 form of teaching at Oxford and Cambridge, but were 
 ignorant of the kind of study required at other Univer- 
 sities in the United Kingdom both for Arts and Medicine. 
 They were satisfied that the only way, in fact, to main- 
 tain a high standard of culture and medical knowledge 
 at the College was to admit those only to the Fellow- 
 ship who possessed the passport of an education gained 
 at either Oxford or Cambridge. 
 
 The pen was largely used by the opposing sides, 
 and " letters," " addresses," and " reflections " for and 
 against were issued. 1 So high ran the feeling that in 
 
 1 Among these, see "A Letter from a Physician in Town," 1753. 
 "An Attempt to Reconcile All Differences," 1753. "An Address to 
 the College," 1747. "Letters Addressed to the College." Faulkner, 
 1829.
 
 DURING THE REIGN OF GEORGE III 29 
 
 1767 the Licentiates attempted by force to attend the 
 College meetings, and on one occasion actually succeeded 
 in forcing the doors. The literary value of these pam- 
 phlets is not of a high order, but exceptions must be 
 made of the " General View " of Ferris, and the weighty 
 "Letter to Lord Kenyon " by Dr. Wells, 1 both of 
 which are even models of what such polemical writing 
 should be. In another class is " The Battle of the Wigs," 2 
 a mock heroic poem in imitation of Garth's " Dispen- 
 sary," by Bonnell Thornton, wherein the disputes 
 between the two factions are described and ridiculed. 
 
 The whole matter was then tested in the Courts in 
 the famous actions of " Rex v. Dr. Askew," and " Rex 
 v. The College." 3 These trials took place in 1768-9 and 
 1769-71. They were heard at great length, and arose 
 out of an application by Dr. Letch, Dr. Archer, and Dr. 
 Fothergill for a rule calling upon the Censors to show 
 by what authority they exercised their powers and 
 functions. The cases were heard by Lord Mansfield, Mr. 
 Justice- Aston, and Mr. Justice Yates. The main 
 question was whether or not the College had power to 
 make such bye-laws and rules as they thought fit, and 
 this was decided in their favour. But the words of the 
 great Lord Mansfield in delivering judgment were 
 remarkable, and left no doubt that he thought the 
 College was insisting too rigidly on its rights. He cau- 
 tioned the College against " narrowing their grounds of 
 admission so much, that if even a Boerhaave should be 
 resident here, he could not be admitted to their Fellow- 
 ship." He said, " I would recommend the College to 
 take the best advice in reviewing their statutes, and to 
 attend to the design and intention of the Crown and 
 Parliament in their institution. I see a source of great 
 
 1 "A General View of the Establishment of Physic." Ferris, 195. 
 ' Letter to Lord Kenyon." Wells, 1795. 
 
 1 "The Battle of the Wigs." Bonnell Thornton, 1778. 
 
 1 For the full report of these cases, see " Burrows' Reports," Vols. IV 
 and V, Rex . Askew, and Rex v. R. C. P.
 
 30 MEDICINE IN ENGLAND 
 
 dispute and litigation in them as they now stand. 
 There has not, it would seem, been due consideration 
 had of the Charter, or legal advice in framing the bye- 
 laws." As a result of Lord Mansfield's warning, the 
 College passed a new bye-law by which Licentiates 
 could be admitted to the examination for the Candidates 
 for the Fellowship. But the new statute was all but 
 inoperative, for, after having been proposed by a 
 Fellow, the Licentiate was required to undergo three 
 examinations, and the result of each examination, 
 and the final admission as a Candidate for the Fellow- 
 ship, depended on a vote of the majority of the Fellows 
 present. So long, therefore, as the Fellows were almost 
 unanimously opposed to the admission of Licentiates 
 to their body there was little probability that a Licen- 
 tiate would be allowed to come within the fold. 
 
 On May 16th, 1797, the whole subject was again 
 raised in the Courts by Dr. Christopher Stanger, who 
 applied to the Court for a mandamus commanding the 
 College to show cause why he should not be examined 
 for the position of Candidate for the Fellowship. The 
 case was argued before Lord Kenyon, and the case for 
 the College was in the able hands of Erskine. The com- 
 position of the Court was peculiar. Lord Kenyon had 
 been for many years the standing counsel for the 
 College, and was consulted regarding the drafting of the 
 bye-laws after Lord Manfield's judgment. Of the other 
 judges, Mr. Justice Lawrence was the son of a former 
 President of the College, while Mr. Justice Grose and 
 Mr. Justice Ashurst, the two remaining judges, were 
 University men. Erskine told Dr. Stanger that he would 
 much rather have pleaded his cause, but that counsel were 
 like hackney coachmen, " First come, first served." 1 
 When the case opened Erskine at once cut the ground 
 from under the feet of Stanger by citing the bye-law 
 
 1 See Stanger' s evidence before the Select Committee of the House of 
 Commons, "Parliamentary Papers," 1834, p. 201.
 
 DURING THE REIGN OF GEORGE III 81 
 
 passed after Lord Mansfield's admonition. He said, in 
 effect, that Dr. Stanger could go before the College and 
 be examined, and that the College could elect him to the 
 Fellowship. Lord Kenyon agreed that the bye-law limit- 
 ing the Fellows to the graduates in medicine of Oxford and 
 Cambridge was bad, but since the College had passed a 
 bye-law by which Licentiates could be examined for the 
 position of Candidates for the Fellowship, he thought the 
 bye-laws reasonable. He said, " If any one of the Fellows 
 proposes Dr. Stanger, he goes to that tribunal which I 
 hope and believe is the sanctuary of good faith and 
 honour ; . . . they are not bound to admit him, all they 
 are bound to do is to examine him." 1 
 
 After this case had been decided, Dr. William Wells 
 determined to put the matter to the test in his own 
 person, in order to see if the College would do that 
 which they had expressed themselves as willing to do 
 when before the Court, viz. to examine for the position 
 of Candidate for the Fellowship any Licentiate who was 
 proposed by a Fellow. Accordingly, Dr. David Pitcairn 
 proposed, and Dr. Matthew Baillie seconded, that Dr. 
 Wells should be allowed to present himself for examina- 
 tion. The College, however, refused the request, 
 thereby deciding that the very bye-law on which they 
 relied before the Court in May, 1797, was inoperative in 
 September of the same year. Again Dr. Wells was 
 proposed, but again various excuses were resorted to in 
 order to prevent him from being examined. Then he 
 desisted, for it was obvious that persistence was useless. 
 Thus, William Charles Wells, Fellow of the Royal 
 Society, Physician to St. Thomas's, and author of tfye 
 " Essay on Dew," failed to become a Fellow of the 
 College. His " Letter to Lord Kenyon," dealing with 
 this episode, on account of its manliness, its spirit, its 
 cogent reasoning, and its literary charm, should be read 
 
 1 For the full report of this case, see " Law Reports," Rex v. College 
 of Physicians, 1797.
 
 32 MEDICINE IN ENGLAND 
 
 almost as a model of what such specimens of composi- 
 tion should be. A few years later the President caused 
 Dr. Wells to be asked if he still had any desire to become 
 a Fellow, but to this he drily replied that he had 
 
 none. 
 
 This treatment meted out to Wells by the College 
 had an unfavourable effect upon its reputation in after 
 years. In 1834 a Select Committee of the House of 
 Commons sat to enquire into the education and practice 
 of various branches of the medical profession, and the 
 case of Wells was made of capital importance by the 
 Committee. Almost every witness was asked his 
 opinion of the fitness of Wells to be a Fellow, and, to 
 their credit, all, save one, admitted his great medical 
 and scientific abilities as well as his unblemished 
 character. Dr. William Macmichael, however, sought 
 to depreciate the position of Wells in words which 
 sound strange coming as they did from one who had 
 been entrusted with the task of writing the " Lives of 
 British Physicians." He said, " I am not aware that 
 Dr. Wells was ever an eminent physician. He wrote 
 some papers for the Royal Society on Dew, and was 
 considered a clever man." After the Chairman had 
 enumerated some eighteen papers by Wells, all dealing 
 with medical subjects, he said, " There is one paper I 
 do remember which is a very important one ; that on 
 rheumatism of the heart, all the others are such as the 
 magazines and publications abound with at the present 
 day. He is not the author of any great work." But the 
 opinion of Dr. Macmichael is of no moment now, for 
 inexorable Time has passed her judgment. 2 
 
 1 For a full account of this case see "A Letter to Lord Kenyon," 
 Wells, 1799, and Stanger's "Justification," 1798. 
 
 3 See "Parliamentary Papers," 1834, "Select Committee of House 
 of Commons to enquire into medical education," and see page 39 
 fop Macmichael's evidence. While pointing out that Wells was more 
 tcientific than medical Macmichael in the same breath instances Wollas- 
 son as an example of an eminent physician : Wollaston who divorced
 
 DURING THE REIGN OF GEORGE III 33 
 
 After the Parliamentary Committee had made a 
 Report, the rule regarding the admission of Fellows 
 was amended in such a way that a Licentiate could be 
 admitted to the candidates' examination for the Fellow- 
 ship without first becoming a Doctor of Medicine of 
 either Oxford or Cambridge. The contest, therefore, 
 which had lasted nearly a century, was ended, and the 
 passions it had raised were stilled. 
 
 At the present day, the phases through which this 
 contest passed have only an academic interest, and 
 scarcely, perhaps, require notice except as forming part 
 of the medical history under review. It may, however, 
 be observed that out of this contest sprang those wise 
 principles which govern at the present time the election 
 of Fellows to the Royal College of Physicians. 
 
 THE MEDICAL PRESS 
 
 The development of the Medical Press during the 
 age of George III has still to be considered. In those 
 days no journals existed which dealt with the politics, 
 the aims, and the aspirations of the medical profession. 
 When a reformer arose his only method of dissemi- 
 nating his views was by means of " Letters," " Obser- 
 vations," and " Considerations." Most of these tracts, 
 a splendid series of which exists in the library of the 
 College of Physicians, are anonymous, and sometimes 
 trivial, but to the student of the period they are 
 often invaluable. 1 In the same way, apart from 
 published books on medical subjects, many short mono- 
 
 himself entirely from medicine in his thirty-fourth year ! The evi- 
 dence given in this enquiry is invaluable from the point of view of the 
 history of medicine. It may be remarked also that it contains the 
 dramatic evidence of Clift regarding the destruction of Hunter's manu- 
 scripts by Sir Everard Home. 
 
 1 Many of these compositions will be found, bound up with short 
 monographs dealing with medical subjects, in the library of the College 
 of Physicians. It is hardly possible to obtain a picture of bygone 
 medical times without recourse to this species of medical literature.
 
 84 MEDICINE IN ENGLAND 
 
 graphs gave us the first introduction to new ideas and 
 discoveries in medicine. During the reign many 
 attempts were made to establish periodical medical 
 publications. Some of them met with a fair share of 
 success, and flourished for a number of years, but many 
 survived only a short time. Dr. Dawson Williams has 
 pointed out that the first English journal devoted to 
 medicine appeared so long ago as 1684, but two numbers 
 only were issued. This was followed in 1737 by " Medical 
 Essays and Observations," published in Edinburgh, and 
 continued until 1757. But with these two exceptions 
 no medical journals existed until the reign of George III. 
 In 1757 " Medical Observations and Enquiries," 
 promoted by a Society of Physicians, was established, 
 and for many years enjoyed a considerable popularity. 
 The next journal to appear was the " Medical Museum " 
 in 1763, a volume devoted to " Select Cases and Ex- 
 periments and Discoveries in Medicine and Pharmacy." 
 The following year " Medical Essays and Observations " 
 made its appearance, and was composed of abridged 
 Memoirs of the Royal Academy of Sciences in Paris. 
 After this in 1767 the " Medical Transactions " of the 
 College of Physicians was begun, at the instigation of 
 the elder Heberden. Six volumes of these "Trans- 
 actions " were published, the last appearing in 1820. 
 The " London Medical Journal " was founded in 1781 
 by Dr. Simmons, who was its first editor, and in 1791 
 it was continued as " Medical Facts and Observations." 
 Dr. Simmons was also responsible for the " Medical 
 Communications " which began in 1784 as the journal 
 of the " Society for Promoting Medical Knowledge," 
 but after two volumes were issued it ceased in 1790. 
 Three volumes of the " Medical Spectator " were pub- 
 lished between 1791 and 1796, and two of the " New 
 London Medical Journal " in 1792-3. In 1793 the 
 " Society for the Improvement of Medical and Chir- 
 urgical Knowledge " issued its first volume of Trans-
 
 DURING THE REIGN OF GEORGE III 35 
 
 actions, and at intervals two other volumes were 
 published, the last appearing in 1812. They were all 
 edited by Dr. Wells. The " Medical and Chirurgical 
 Review " began its career in 1795, and continued until 
 1807. In 1799 the " Medical and Physical Journal " 
 first appeared, and survived until 1833. The " London 
 Medical Repository " was first published in 1814, and 
 under various titles continued to appear until 1836. 
 Besides these periodical publications, the Transactions 
 of the Medical Society and of the Medico-Chirurgical 
 Society were being issued from time to time. The list 
 is a full one, and bears striking testimony to the great 
 activity taking place in every branch of medicine during 
 the closing years of the eighteenth century. 1 
 
 It was not until 1823 that the " Lancet " appeared, 
 and quickly enjoyed a wide popularity. The cause of 
 its success was to be found in its powerful advocacy of 
 medical reform, which was sadly needed, and in the 
 great ability with which it was conducted. It not only 
 appealed to the strictly medical mind, but also to the 
 more progressive spirits in the profession, who relished 
 its truculent tone towards existing medical authority. 
 Its methods were sometimes questionable, but always 
 undeniably clever, and when such matter as the incom- 
 parable " Intercepted Letters " by Wardrop appeared, 
 although the medical world was convulsed with laughter, 
 the fact cannot be denied that the good taste of such 
 journalism was doubtful. 2 
 
 1 For a full list of all the medical periodicals see Appendix. 
 
 2 See the earlier numbers of the " Lancet,'' and especially the issues 
 of the years 1833-36 for the " Intercepted Letters." See also the "Life 
 of Thomas Wakley," Sprigge, and "Autobiographical Reminiscences of 
 the Medical Profession," Clarke.
 
 CHAPTER II 
 
 THE ADVANCE OF MEDICAL KNOWLEDGE 
 
 9 
 
 IN the previous chapter the general conditions under 
 which medicine in England existed during the reign of 
 George III were sketched. In this chapter it is pro- 
 posed to give some account of the individual work of 
 physicians of that period. For the purposes of this 
 enquiry, the work of those physicians who contributed 
 to the advancement of medical knowledge will be con- 
 sidered, and after that an estimate will be made of 
 those who widened the boundaries of general science. 
 
 An investigation of this kind will not be without in- 
 terest and profit, for it will bring us into closer contact 
 with the personalities of those distinguished physicians 
 who belonged to and influenced that medical age. But 
 in appraising the work performed by these physicians 
 little will be added to our stock of knowledge if we 
 approach the subject in any captious spirit of criticism. 
 We are often apt, in the light of later knowledge, to 
 belittle the attempts of early investigators in the field 
 of science. We see where they were blind ; we can 
 fill in the lacunae in the chain of facts where they failed, 
 and we forget that future ages may justly smile at 
 our own puny efforts to unravel the mysteries of 
 Nature. 
 
 The sources of information concerning the physicians 
 of the age of George III are ample, but it must be con- 
 fessed that most writers, in estimating the characters 
 and life-work of their heroes, have adhered too closely, 
 perhaps, to the dictum " de mortuis nil nisi bonum." 
 
 36
 
 DURING THE REIGN OF GEORGE III 8T 
 
 This is to be regretted, for however pleasing it may be 
 to think that our profession has been content to deal 
 kindly with the reputations of those who may have 
 been rivals and competitors, the student prefers a pen- 
 portrait with all the blemishes depicted. The medical 
 writings of the age of George III can be studied, and a 
 judgment passed concerning their merit, but for a 
 knowledge of the personal characteristics of the phy- 
 sicians, recourse must be had to the " Gentleman's 
 Magazine " the " Roll of the College," and the " Dic- 
 tionary of National Biography." Some few of the more 
 eminent physicians have attained to the dignity of a 
 complete " Life," but for the large majority, these 
 three sources of information just mentioned form, 
 almost, our only guide to the lives and characters of 
 the physicians of this period. Of first importance as 
 contemporary evidence are the memoirs and obituary 
 notices of physicians found scattered over the pages of 
 that repository of biographical knowledge the " Gentle- 
 man's Magazine." These appreciations were written 
 by men who were personally acquainted with the 
 subjects of their memoirs, and it appears that trouble 
 was taken to place the work of writing these notices 
 in competent hands. Thus we know that the memoirs of 
 David Pitcairn, George Fordyce, and Andrew Wilson 
 proceeded from the able pen of Dr. Wells, and many 
 others were undertaken by men equally qualified. The 
 " Roll of the College " is a monument to the industry 
 and ability of Dr. Munk, and is indispensable to the 
 student of medical biography. Of course, in such a 
 work, composed as it is of an enormous mass of facts 
 and dates, absolute infallibility cannot be expected. 
 But it may be stated with safety that few works of 
 reference contain so few mistakes. Although the spirit 
 in which Munk's biographies have been conceived may 
 be somewhat lacking in fearless criticism, yet as a whole 
 the work is admirable in point of style and justness.
 
 38 MEDICINE IN ENGLAND 
 
 Then the authors of " The Lives of British Physicians " 
 have contributed much to the subject of medical 
 biography, and the same may be said of Pettigrew and 
 Aikin. They are all, however, open to the criticism 
 that they make the subjects of their memoirs appear to 
 be perfect paragons of private and professional virtue. 
 Very valuable information conceming the Fellows and 
 Licentiates of the College of Physicians during the first 
 twenty years of the nineteenth century will be found in 
 an anonymous work published in 1817, and entitled " A 
 Picture of the College of Physicians." The biographies 
 have considerable merit, and the author, whoever he 
 may be, has exhibited a fairness and candour, in dealing 
 with his subjects, worthy of praise. Finally, to complete 
 the list of the sources of information respecting medical 
 biography, mention must be made of the memoirs in 
 the " Dictionary of National Biography." These may 
 be regarded as the final pronouncements upon the lives 
 and work of physicians of the past, founded on a study 
 of all accessible authorities. The author of most of 
 these memoirs is Dr. Norman Moore, and having said 
 that it is only necessary to remark that the work could 
 not have been placed in more capable hands and that 
 the results are fully equal to the great reputation 
 enjoyed by that writer of medical history. 
 
 Taken as a whole, the medical writings of the reign 
 of George III exhibit a high degree of literary ex- 
 cellence, and often compare favourably with works of 
 the same class at the present time. This is not a matter 
 for surprise, for in those days a physician was gener- 
 ally possessed of considerable literary culture. At 
 most Universities, and especially at Oxford and Cam- 
 bridge, it was incumbent upon him to proceed to a 
 degree in Arts, preparatory to the study of medicine, 
 and the comprehensive nature of the instruction in 
 Arts has already been described in the first chapter. 
 While it may be true that the literary style of many
 
 DURING THE REIGN OF GEORGE III 39 
 
 medical works at this period savours too much of a 
 rigid classical training, it is nevertheless a fact that 
 many of them are almost models of clear exposition 
 and elegant diction. 
 
 A review of medical work during the reign of George 
 III, with special attention to its prominent exponents, 
 may now be attempted. At the commencement of the 
 reign, medicine was awakening from its long slumber, 
 and the spirit of Harvey and Sydenham was beginning 
 to reassert itself. The restricting and unsettling in- 
 fluence of the various " Systems " ceased to hamper the 
 thoughts of physicians. They began to observe, to 
 appeal to their own experience of disease, and to 
 attempt to shape their views and practice in accordance 
 with demonstrable facts. A race of pure clinicians 
 arose, but as yet the fruits of the study of morbid 
 anatomy, physiology, and chemistry were not within 
 its reach. Still, using such means as they possessed, 
 physicians became remarkably acute observers, and 
 among them reckoned some of the greatest clinicians 
 this country has produced. 
 
 An excellent idea of the scope of medicine taught 
 during the first thirty years of the reign can be formed 
 from a study of " The Elements of the Practice of 
 Physic " by George Fordyce, 1 the celebrated physician 
 of St. Thomas's Hospital. This book was, apparently, 
 the student's text-book of those days, and enjoyed a 
 wide popularity, passing through many editions. 
 Fordyce was engaged for thirty years in lecturing on 
 medicine at his house in Essex Street, Strand, and the 
 " Elements of the Practice of Physic " may be taken 
 as the substance of what he was accustomed to teach 
 at these lectures. Some hundred pages of the book 
 are devoted to the Natural History of the Human 
 Body, or in modern terms, physiology. As might be 
 
 1 "The Elements of the Practice of Physic," Geo. Fordyce. Fifth 
 edition, 1784. First edition, 1770.
 
 40 
 
 expected, at that early period in the history of physi- 
 ology, the knowledge shown of this science was decidedly 
 scanty, but nevertheless surprisingly free from gross 
 errors. 1 The remaining part of the volume deals with 
 the Symptoms, Distinctions, Prognostics, and Cure of 
 Fevers and Inflammations, and under these headings 
 is included the whole of the morbid conditions phy- 
 sicians were called upon to treat. In accordance with 
 the doctrines regarding fevers prevalent at that time, 
 little attempt is made to differentiate and classify the 
 various forms, and the subject is treated of more or 
 less as an entity. So also with inflammations ; they 
 were generalised so far as symptoms were concerned, 
 and as to treatment, if they were sthenic, they called 
 for revulsive measures, if asthenic, for tonics and 
 stimulants. It is to be regretted that George Fordyce 
 is remembered to-day more on account of his gastro- 
 nomic feats at Dolly's Coffee House than for his long life 
 of honest work in the cause of medicine. He was, 
 indeed, a sagacious and scientific physician far in 
 advance of his time, facts which rest on the assertion 
 of so uncompromising a critic as Dr. Wells. He made 
 no use of morbid anatomy as an aid to the practice of 
 medicine, but he imparted to his pupils what was 
 known of chemistry and physiology. 2 
 
 Time does not permit of a detailed description of the 
 characteristics of all the physicians who attained to 
 eminence as clinicians during the first forty years of 
 the reign, but some may be selected as typical of them 
 all. The first to be mentioned is William Heberden the 
 elder, and if terms partaking of exaggeration are used 
 in speaking of that good and great man, the excuse 
 
 1 Fordyce was evidently acquainted with the labours of Haller, 
 Reaumur, and Spallanzani with reference to Digestion and Respiration. 
 
 a For an excellent account of the life and work of George Fordyce 
 see " The Gentleman's Magazine " for June, 1802, from the pen of his 
 friend and colleague W. C. Wells.
 
 DURING THE REIGN OF GEORGE III 41 
 
 must be that the more one studies his life and work the 
 less one finds to criticise and belittle. For Heberden 
 is the great prototype of the modern clinician, the con- 
 necting link between Sydenham, and Bright, Addison 
 and Watson. His " Commentaries," the book by 
 which his name will be for ever perpetuated, was pub- 
 lished after his death in 1801, but contains the results 
 of his study and experience extending over sixty years. 
 Remembering the time in which he lived, and the state 
 of medical knowledge, it is truly a wonderful work, 
 and must have acted on the medical world of that age 
 like a refreshing breeze over arid and parched tracts. 
 So sound is its doctrine, so cautious its treatment, and 
 so endowed with excellent common sense, that much 
 of it would require but little editing at the present day. * 
 Here we find no fantastic theories, no appeal to meta- 
 physical disquisitions, but simply the results of a close 
 observance of signs and symptoms of disease at the 
 bedside by an acute observer. Throughout the book 
 Heberden strikes a note of honest pessimism, and when 
 his knowledge and experience fail him, he is too great 
 to be ashamed to own it. He shows also a righteous 
 contempt for the vaunted specifics, and an adamantine 
 refusal to accept anything incapable of proof, on what- 
 soever authority it might be stated. Almost in sorrow 
 he closes his luminous pages with a humble apology 
 for having been able to say so little that was valuable 
 concerning a subject upon which he had been engaged 
 for the whole of his long professional life. He even 
 ventures the opinion that there was not much prospect 
 of an advance in medical knowledge unless a prodigy, 
 such as a medical Newton, should arise. Such was 
 Heberden's book ; the first clinical manual that had 
 
 1 Yet Dr. Thomas Young, in his " Treatise on Consumption " has 
 referred in slighting terms to the " Commentaries." Compare, however, 
 this mine of observation and experience with Young's " Treatise," where, 
 beyond a compilation of what others have said, Young has scarcely con- 
 tributed a single observation of his own worth recording.
 
 42 MEDICINE IN ENGLAND 
 
 appeared. As a practical physician his reputation was 
 already beyond the reach of criticism at the hands of 
 his contemporaries, and with the " Commentaries " 
 before them, successive ages of physicians will un- 
 reservedly endorse that verdict. 1 
 
 Of Heberden's great qualities as a man and a scholar 
 it is unnecessary to speak, for those, and his peculiarly 
 endearing personality, have often been portrayed. 
 Fortunate must have been the patient who came under 
 his able and tender hands. 
 
 Many well-known eulogies of the character and work 
 of Heberden are in print, but one noble appreciation, 
 the finest of all, is wellnigh forgotten, and since it 
 comes from the pen of Dr. Wells, who was no flatterer, 
 it may be quoted. He says : " Dr. Heberden stands 
 alone in his profession. No other person either in this 
 or any other country has ever exercised the art of 
 medicine with the same dignity, or has contributed so 
 much to raise it in the estimation of mankind. Were 
 I possessed of talents adequate to the undertaking, I 
 should attempt to describe at full length the character 
 of that illustrious man. In this attempt I should first 
 mark his various and extensive learning, his modesty 
 in the use of it, and his philosophical distrust of human 
 opinions, however sanctioned by time or the authority 
 of great names. I should then exhibit him in the 
 exercise of his profession, without envy or jealousy, too 
 proud to court employment, yet undervaluing his 
 services after they were performed. Unwearied, even 
 when a veteran in his art, in ascertaining the minutest 
 circumstances of the sick who placed themselves under 
 his care, taking nothing in their situation for granted 
 that might be learned by enquiry, and trusting nothing 
 
 1 Besides the " Commentaries," Heberden's Gulstonian Lectures 
 exist in manuscript in the library of the College, and are delightful 
 reading. The first three volumes of the "Transactions of the College'" 
 also contain many papers read by him.
 
 DURING THE REIGN OF GEORGE III 43 
 
 of importance that concerned them to his memory. 
 To demonstrate the greatness of his mind, I should 
 next mention his repeatedly declining to accept those \ 
 offices of honour and profit at the British Court, which 
 are regarded by other physicians as objects of their 
 highest ambitions, and are, therefore, sought by them 
 with the utmost assiduity. I should afterwards take 
 notice of his simple yet dignified manners, his piety to 
 God, his love for his country, and his exemplary dis- 
 charge of the duties of all private relations in which 
 he stood to society, and I should conclude by observing 
 that his whole life had been regulated by the most 
 exquisite prudence. After my description was finished, 
 I should think it proper to say that I had never been 
 acquainted with Dr. Heberden, and consequently 
 could neither be dazzled by the splendour of his virtues 
 from approaching them too nearly, nor influenced in 
 my opinion concerning them by benefits he had already 
 conferred upon me ; and that standing as he does on 
 the verge of this state of existence ready to wing his 
 flight to another glory, his ear must be closed to the 
 voice of flattery, had he ever listened to that syren, or 
 were I base enough to solicit her aid in the foolish 
 expectation of receiving from him some future 
 reward." 1 
 
 Another of the great clinicians of this period was 
 Sir George Baker, the distinguished President of the 
 College of Physicians. But for one piece of epoch- 
 making work he would have passed into history as an 
 accomplished physician who enjoyed a more than 
 usually large share of public favour, and whose classical 
 attainments were of a higher order than those of any 
 other physician, with the exception of Samuel Musgrave. 
 Fortunately for posterity he investigated the cause of 
 lead colic in Devonshire, and the result of this work 
 
 1 The above eulogy occurs in "The Letter to Lord Kenyon," Wells, 
 1799.
 
 44 MEDICINE IN ENGLAND 
 
 is contained in a series of essays, 1 which may be justly 
 quoted as models of inductive logic. It is not so much 
 on the score of originality that Baker's essays are re- 
 markable, for it had already been pointed out by 
 Bouvart, Wall, and Zeller that lead held in solution in 
 wines was the cause of plumbism at Poitou and other 
 places. But it was the accurate reasoning contained 
 in the essays that won for them such lasting renown. 
 There is the irresistible marshalling of facts, the proof 
 that the facts are indisputable, and the unerring deduc- 
 tions drawn therefrom which established for all time 
 that the colic in Devonshire was produced by the 
 presence of lead in the cyder. The chemical part of 
 the enquiry was beyond the power of Sir George 
 Baker, and this was placed in the hands of Dr. 
 William Saunders of Guy's Hospital, and a portion 
 of the credit for this undertaking is certainly due to 
 him. 
 
 Now, this investigation concerning the nature of 
 colic was first begun by Baker at the little village of 
 Alphington in 1765, and is, therefore, one of the first 
 attempts to grapple with a medical problem by means 
 of the experimental method. No speculations were 
 advanced, and the results of the experiments were the 
 sole grounds for the deductions made. 
 
 A year previous to the work on Devonshire colic 
 Baker had published an enquiry, scarcely less import- 
 ant, concerning the question of inoculation of small- 
 pox. 2 Here, again, it is incontrovertible facts that he 
 seeks. He gives an account of the method of per- 
 forming inoculation, and the results as obtained by 
 Dr. Pulteney in the town of Blandford, where thirteen 
 
 1 The Essays appeared first in the " Transactions of the College," 
 Vol. I, pp. 17.5-406, and were read in June, July, and August, 1767. 
 Afterwards they were published in one volume entitled " Essays con- 
 cerning the Cause of the Endeiuial Colic of Devonshire." 1767. 
 
 2 "An Enquiry into the Results of a Method of Inoculating Small- 
 Pox." 1766.
 
 people died out of a total of 350 submitted to the 
 operation. 
 
 Of Baker's merits as a practitioner we can only judge 
 from the opinions formed by his contemporaries, and 
 these were universally favourable. Indeed, few phy- 
 sicians were so respected, and not the least of his amiable 
 qualities was his kindness shown to young physicians 
 about to engage in practice in the metropolis. 1 
 
 Other physicians during the last forty years of the 
 eighteenth century attained great celebrity as clinicians, 
 but since they have contributed little or nothing to 
 medical literature it becomes difficult to assess their 
 real merit. Contemporary evidence, however, is almost 
 unanimous in according them high praise, and the 
 estimates then formed must be accepted. Certainly 
 no doubt can exist concerning the clinical abilities of 
 Richard Warren, the two Pitcairns, Robert Gooch, and 
 John Fothergill, and perhaps the same may be said of 
 Henry Revell Reynolds and Sir Lucas Pepys. Coming 
 much later, but belonging to the same class, was Sir 
 Henry Halford, who may be regarded as almost the 
 last of the old-time clinicians. He occupied for many 
 years a conspicuous place in medicine, but great diffi- 
 culty is encountered when the attempt is made to 
 assign him his particular place. The enormous debt 
 the College owes him for having been instrumental in 
 placing the College on its present site, and for the ad- 
 mirable way in which he maintained its dignity, author- 
 ity, and privileges for more than twenty years through 
 most trying times, no one will for a moment deny. 
 Nor will it be possible to contest the statement that his 
 classical erudition was of a high order, and that he 
 enjoyed a success in the practice of medicine beyond 
 
 1 It should also be remembered to the credit of Sir George Baker 
 that he was instrumental in finding funds to send Richard Porson to 
 Cambridge. But for this act of kindness the world might have lacked 
 the greatest Greek scholar.
 
 46 MEDICINE IN ENGLAND 
 
 most others. 1 But as to his claim to rank as an eminent 
 exponent of the art of clinical medicine, it is quite 
 possible, from such evidence as is available, to form 
 hypotheses for and against that contention. The life 
 and character of Halford have been presented to us 
 from two distinct points of view. There is the admir- 
 able eulogy by Dr. Munk, 2 in which scarce an imper- 
 fection is admitted, save some slight hastiness of temper, 
 and a tendency to carry the manners of the Court into 
 private life. There are, also, the clever but unscrupu- 
 lous " Intercepted Letters " of Wardrop, 3 in which 
 every vulnerable part of Halford's character is exposed 
 and ridiculed with a merciless satire and a biting 
 sarcasm that reminds one of Voltaire in his most pungent 
 mood. These represent the two sides of the picture, 
 but are not of any great value as a contribution to 
 historical accuracy. Halford may have been an ex- 
 cellent diagnostician, he certainly was an excellent 
 prescriber, but in the midst of the pronounced advances 
 that were being made in clinical methods he clung to 
 the old traditions, and refused, to the end of his life, 
 to have anything to do with the stethoscope. Perhaps 
 the truth about Halford may be found to lurk in the 
 fact that to a fair knowledge of medicine he united a 
 shrewd and profound knowledge of mankind, and so 
 succeeded where others failed. 
 
 But towards the end of the eighteenth century the 
 existing order of clinical physicians, who depended for 
 their medical acumen upon knowledge gained entirely 
 
 1 It is often difficult to estimate the ability of physicians as classics. 
 For instance, the Harveian Oration of Dr. John Latham has been de- 
 scribed by Halford as a model of graceful Latin, but Dr. Wells, equally 
 competent to judge, has described it as full of mistakes in grammar that 
 would shame a schoolboy. 
 
 9 " Life of Sir Henry Halford," Munk, 1895. 
 
 3 See the " Lancet," 1834-37, under the heading " Intercepted 
 Letters." Although undeniably clever they are a sad commentary on 
 the bitter state of feeling in the profession of those days.
 
 DURING THE REIGN OF GEORGE III 47 
 
 at the bedside, was beginning to be replaced by a race 
 of men who enlisted the sciences of Chemistry, Anatomy, 
 and Physiology for the purpose of elucidating the 
 problems connected with disease. The pure clinician 
 had reached a point beyond which it was almost im- 
 possible to advance. However much he might know 
 concerning symptoms and their treatment, he could 
 never attain to any real knowledge of disease without 
 a study of the morbid anatomical and physiological 
 conditions which caused it. His treatment, therefore, 
 was entirely symptomatic, and he was inclined more 
 and more to simplify and classify symptoms, while 
 disregarding their true causes. His race was run, and 
 he was compelled to make way for men with better 
 equipment. 
 
 Why the sciences of Anatomy, Chemistry, and Physi- 
 ology should have become dormant for nearly seventy 
 years, after having given such remarkable promise at 
 the end of the seventeenth century, it is most difficult to 
 explain. But the fact remains that until Morgagni, 
 Lavoisier, and Haller respectively rekindled the enthu- 
 siasm for Anatomy, Chemistry, and Physiology, nothing 
 of great importance had been accomplished for more 
 than half a century. 1 Morgagni revived Anatomy, 
 Haller 2 Physiology, and Lavoisier gave the coup de grace 
 to the theory of Phlogiston which had cramped and 
 starved Chemistry for nearly a hundred years. After 
 the efforts of these three great men, the three sciences 
 made rapid strides, and soon were in a position to lend 
 their powerful aid to medicine. ^ 
 
 Anatomy was the first science to be seriously applied 
 to the service of practical medicine, and by its aid the 
 
 1 Haller published his "Elementa Physiologiae " in 1757. Lavoisier 
 his " Sur la Nature du Principe" in 1775, and the English Translation of 
 Morgagni's " De Sedibus et Causis Morborum " appeared in 1769. 
 
 1 The work of Haller on Respiration, and of Reaumur and Spallanzani 
 on Digestion contributed much to the practical application of Physiology 
 to medicine.
 
 48 MEDICINE IN ENGLAND 
 
 medical vision was projected from the bedside to the 
 post-mortem table. From time almost immemorial in 
 the history of medicine human anatomy had been 
 thoroughly taught, but mainly for the purpose of im- 
 parting a knowledge of the structure of the healthy 
 human frame. But the possibilities of its practical 
 application to the problems of disease were scarcely 
 appreciated. This is somewhat strange when it is 
 remembered that the best teachers at this time were 
 physicians, among whom may be mentioned William 
 Hunter, Frank Nicholls, James Douglas, James Parsons, 
 Thomas Lawrence, and Matthew Baillie. 
 
 The desire to profit in medicine from knowledge 
 gained by an examination of diseased parts on the post- 
 mortem table received its first important stimulus in 
 this country from the publication in 1769 of Dr. Alex- 
 ander's translation of Morgagni's great work, " De 
 Sedibus et Causis Morborum per Anatomen Indigatus." 1 
 In this work of the great Italian anatomist, for the first 
 time anatomical knowledge was systematically devoted 
 to the service of medicine. Not content with the mere 
 description of the healthy parts of the human body, 
 Morgagni broke with the somewhat inept tradition, and 
 applied his knowledge to an anatomical investigation 
 of diseased parts, in the endeavour to explain the 
 symptoms and signs observed during the progress of 
 disease. For all time he must be honoured as the first 
 man to present a comprehensive picture of the possi- 
 bilities of the study of morbid anatomy. But he had 
 his limitations. More of an anatomist than a physician 
 he was apt to pay more attention to the appearances 
 observed after death than to those observed during life. 
 He indicated the main characters of the disease, and 
 laid bare the results obtained on the post-mortem table, 
 but although the logical conclusion to be drawn ap- 
 peared often to be irresistible, he hesitated one had 
 
 1 Morgagni published this book in 1761 when he was in his eightieth year.
 
 DURING THE REIGN OF GEORGE III 49 
 
 almost said feared to clinch the matter by a bold 
 deduction. 
 
 Bichat, the Napoleon of French medicine, carried 
 on and advanced the study of morbid anatomy. What 
 he accomplished in an all too brief life of thirty-one 
 years does not belong to these lectures, but his 
 name must be mentioned in connection with the 
 movement. 
 
 But a greater than either Morgagni or Bichat was 
 about to arise in this country ; great as a physician, 
 great as a morbid anatomist, the father of medical 
 pathology the great figure of Matthew Baillie. 
 With the blood of the Hunters in his veins, bred to 
 anatomical pursuits under the immediate supervision 
 of William Hunter, he stepped into the arena, as it 
 were, in the nick of time. The older clinicians had com- 
 pleted their work, and it remained for Baillie to build 
 a bridge over the gulf by means of which medicine could 
 proceed to further perfection with the assistance of 
 morbid anatomy. This he did by the publication in 
 1793 of his celebrated book " The Morbid Anatomy of 
 some of the Most Important Parts of the Human Body." 
 It was the first English treatise on Morbid Anatomy, 
 and met with instantaneous success. In the preface to 
 the first edition Baillie states in clear language the 
 purpose of his work, which he summarises under four 
 heads as follows : 1. " To explain the changes of 
 structure arising from morbid actions." 2. " To dis- 
 tinguish between morbid changes which have been 
 generally confounded." 3. "To detect diseased altera- 
 tions in the organisation of parts which are but little, 
 or not at all, known." 4. " From the observation of 
 morbid structure, theories taken up hastily about disease 
 will be occasionally corrected." 
 
 Such were the objects of Baillie's book, and from the 
 date of its publication clinical medicine may be said to 
 have obtained a new and extended charter eminently
 
 50 MEDICINE IN ENGLAND 
 
 suited to its needs. The chief characteristics of the work 
 are its admirable conciseness and its accurate observa- 
 tion. Unlike the overloaded volumes of Morgagni, the 
 main important features of morbid anatomy, as described 
 by Baillie, are not obscured by minute accounts of other 
 trivial diseased conditions which played no part in the 
 special morbid process under review. The wonderful 
 plates, produced after the appearance of the book, even 
 when viewed in the light of our present-day mature 
 knowledge of morbid anatomy, are unimpeachable evi- 
 dence of Baillie's unerring accuracy of observation. At 
 that early stage of the study of the subject it could 
 hardly be expected that any general principles regard- 
 ing medical pathology would be enunciated, for Baillie 
 was only building the foundations upon which future 
 workers were to erect the superstructure of the science 
 of pathology. 
 
 Great as was the effect of Baillie's book in this country, 
 it met with almost greater success in Germany, where 
 Professor Soemmering warmly embraced its doctrines 
 and translated it into German. In England it soon 
 began to exert its influence upon medical teaching, and 
 in a little time every book dealing with medicine 
 devoted an increasing space to the subject of morbid 
 anatomy. Baillie, however, scarcely lived to see the 
 full fruits of his pioneer work, and perhaps the import- 
 ance of his innovation was hardly recognised by his 
 immediate successors. But we, who live in the present 
 age, can look back and detect in the work of Matthew 
 Baillie the beginnings of the science of Pathology, which 
 has ever since exercised such a profound influence upon 
 the art of medicine. Indeed, we may almost assert 
 that without Baillie the work of Abercrombie on the 
 pathology of the brain and the intestinal canal, and of 
 Bright on the kidneys, would have been postponed to a 
 much later date. Few Fellows of this College have 
 occupied a higher place.
 
 DURING THE REIGN OF GEORGE III 51 
 
 At about the same time that Baillie was establish- 
 ing the study of morbid anatomy, the sciences of Chem- 
 istry and Physiology were beginning to be seriously 
 applied to the art of medicine. Much progress had been 
 made in these sciences, and at the dawn of the nineteenth 
 century they were so far developed that they were of 
 the greatest service to medicine. 
 
 Previous to 1800 the science of Chemistry was in 
 its cradle, and such teaching as was given was scanty 
 and often erroneous. Still, long before that date the 
 subject had received considerable attention by certain 
 London physicians who were unwearied in their efforts 
 to impart chemical knowledge. Dr. William Saunders, 
 of Guy's Hospital, was one of the first to devote himself 
 to the subject, and from 1766 onwards he lectured on 
 Chemistry, and was justly regarded as one of its leading 
 authorities among physicians. Others who worked in 
 the same field were George Fordyce, William Babington, 
 and Richard Powell. At about this period also the 
 subject of Animal Chemistry began to attract the notice 
 of chemists of eminence, and its study was greatly 
 stimulated by Berzelius, who published his " View of 
 the Progress and Present State of Animal Chemistry " 
 early in the century. 1 But for some time the practical 
 application of Physiological Chemistry to the proper 
 understanding of diseased conditions received but scant 
 notice by physicians, and was little understood. It was 
 reserved for Dr. William Prout to be the first physician 
 who brought to the aid of practical medicine a sound 
 and comprehensive knowledge of Animal Chemistry. 
 Prout' s name stands high in the history of chemical 
 science, and he forms one of the famous quartette of 
 great scientists who adorned the medical profession 
 towards the end of the reign of George III. But, unlike 
 the other members of that quartette, Young, Wollaston, 
 
 1 Young gives a translation of this work in his " Introduction to the 
 Study of Medical Literature," 1813.
 
 52 MEDICINE IN ENGLAND 
 
 and Wells, Prout was distinguished for his practical 
 ability as a physician, and his great attainments in 
 science increased rather than diminished his reputation 
 in this respect. In 1813 he began to lecture on Chemistry 
 at his house in Southampton Street, and was honoured 
 by having Sir Astley Cooper as one of his audience. 
 Animal Chemistry engrossed his attention, and the 
 first results of his researches appeared in 1821, when he 
 published his book, " An Enquiry into the Nature and 
 Treatment of Gravel, Calculus, and other Diseases of 
 the Urinary Organs." It was the first treatise to deal 
 with these diseases from a chemical standpoint, and 
 marks the commencement of our knowledge of these 
 conditions. In later editions of the work, Prout still 
 further elaborated his views, and included the subject 
 of digestion. Many fundamental truths concerning 
 metabolism were first stated by Prout, among which 
 may be mentioned the facts that urea was formed in the 
 blood, and was merely excreted by the kidneys ; that 
 the healthy stomach contained always a percentage of 
 hydrochloric acid. Prout was also the first to enunciate 
 the doctrine of " secondary assimilation," but unfortu- 
 nately these views were, to a certain extent, purloined 
 by Giessen and Justus von Liebig and given to the 
 world under the high-sounding title of the " Metamor- 
 phoses of Tissues." But, always retiring and unob- 
 trusive, Prout left it to others to point out that the 
 theory had been promulgated by him several years 
 before. 
 
 Although Prout may be regarded as the originator of 
 the method of applying Chemical Physiology to the 
 service of practical medicine, he was not the only worker 
 in that sphere. Dr. A. J. Marcet a few years before 
 had published an " Essay on the Chemical History and 
 Medical Treatment of Calculus Disease," a book of the 
 greatest merit, which did credit to his ability as a sound 
 chemist. It is not, however, to be compared with the
 
 DURING THE REIGN OF GEORGE III 53 
 
 work of Prout, which went far beyond it in depth of 
 insight and broadness of conception. Indeed, Prout 
 did for Chemical Pathology what Baillie did for Morbid 
 Anatomy, and must rank with him as a bold and saga- 
 cious innovator. 
 
 While these progressive movements were taking 
 place in medicine and science, Robert Willan was pur- 
 suing his Dermatological investigations at the Public 
 Dispensary in Carey Street. After many years' labour 
 he gave to the world in 1798 his results hi the shape of 
 the first part of his great work on " Cutaneous Diseases." 
 For the first time Willan placed the classification of 
 diseases of the skin on an anatomical basis, from which 
 proceeded all the developments in the knowledge of 
 that subject. In order to appreciate the importance of 
 Wi Han's work, one cannot do better than quote the 
 admirable words of Dr. Pye-Smith, who says : " It is 
 the great merit of Willan that he accurately described 
 the anatomy of the morbid skin." His " orders," the 
 " elementary lesions " of later dermatologists, are the 
 alphabet of the subject, and correspond to the " physical 
 signs " of disease of the lungs. 1 
 
 Scarcely less important was the work of his pupil, 
 Thomas Bateman, who still further advanced the subject 
 of Dermatology. Besides being a pioneer in his special 
 field Willan was a most accomplished clinician, and his 
 abilities in this respect attracted to the Public Dispen- 
 sary a large class of students, many of whom attained 
 to the highest eminence. It is not often that teachers 
 can claim as pupils a Bright, an Addison, a Marcet, and 
 a Biett, but Willan and Bateman enjoyed that dis- 
 tinction. The Public Dispensary is still in existence, 
 yet few know of it as the home of modern Dermatology 
 under the able superintendence of the father of that 
 branch of medicine, Robert Willan. 
 
 The subject of midwifery also made some progress 
 
 1 See Fagge's " Principles of Medicine," first edition, Vol. II, p. 610.
 
 54 
 
 during the reign, and was fostered by many able ex- 
 ponents of the art, among whom may be mentioned the 
 names of Denman, W. Hunter, William Osborne, John 
 Clarke, Hugh Ley, David Orme, and James Ford. 
 Before 1739, apparently, no definite instruction was 
 given in the subject in London, but in that year Smellie 
 arrived in the metropolis and began a course of lectures. 
 In the same year Sir Richard Manningham established 
 a ward in the Westminster Infirmary for lying-in women, 
 and this was the first attempt to find special accommo- 
 dation for the study of midwifery. Soon after this, 
 largely due, no doubt, to the influence of the teaching 
 of Smellie, lying-in hospitals began to be erected, of 
 which the first was the British Lying-in Hospital, 
 founded in 1749 with William Hunter as its first 
 physician. In 1769 Denman, who had been a pupil of 
 Smellie, began a course of lectures in conjunction with 
 William Osborne, and for fifteen years the majority of 
 students attended these lectures. On October 6th, 1783, 
 a greater importance was given to the status of the 
 " man-midwife " by an Act of the College, which allowed 
 those who practised midwifery to become Licentiates, 
 and Thomas Denman was the first physician-accoucheur 
 to receive that distinction. 
 
 For some time the introduction of medical men into 
 the practice of midwifery Was viewed by the public with 
 much disfavour. Considerable commotion was occa- 
 sioned in 1749 when Dr. Frank Nicholls gave lectures 
 to men on the subject. The mid wives and many of the 
 laity were up in arms at this innovation which threat- 
 ened their position, and Dr. Nicholls was under the 
 necessity of explaining away his lectures by the pub- 
 lication in 1751 of his strange pamphlet entitled " The 
 Petition of Unborn Babes to the Censors of the College." 
 Even so late as 1830 a Society was founded, with Sir 
 Anthony Carlisle as its president, for the avowed 
 purpose of regaining for female midwives the position
 
 DURING THE REIGN OF GEORGE III 55 
 
 which had been usurped by the men. The Society was 
 patronised by the Duchess of Kent and many other 
 high-placed dames, some of whom had never been 
 guilty of the impropriety of employing a physician- 
 accoucheur. An extraordinary tract was written in 
 1830 by one M. Adams, entitled " Man-Midwifery 
 Exposed," and scarcely on a much higher plane was 
 the violent address of Sir Anthony Carlisle to His 
 Majesty's Judges and Coroners, published in the 
 " Times " on May 1st, 1830. 
 
 To judge from the views of experts in the subject, it 
 would appear that Smellie must be regarded as the 
 father of modern midwifery, while Hunter and Denman 
 did more than others to improve its practice. After 
 Smellie's day, however, it cannot be asserted that any 
 great advance took place in Obstetrics during the reign 
 of George III. 
 
 The work of those physicians who distinguished 
 themselves in the realm of science during the reign 
 under review must now be considered. There can be 
 no doubt that the ranks of workers in Natural Science 
 were largely recruited, at this period, from the medical 
 profession, of which the College of Physicians con- 
 tributed a goodly share. Indeed, a little reflection will 
 show that it could not have been otherwise, for at this 
 time the sciences of Chemistry, Anatomy, Physiology, 
 and, to a certain extent, Botany were generally taught 
 to those intending to become doctors. Until well after 
 the commencement of the nineteenth century a man 
 devoted to Natural Science could scarcely hope to main- 
 tain himself without the emolument and position that a 
 degree in medicine secured. Many medical men, 
 therefore, were engaged entirely in the study of science, 
 and pursued the practice of the art of medicine with 
 but little enthusiasm. It will not be necessary to 
 mention the names of all those who applied themselves 
 to scientific subjects, but attention will be paid to
 
 56 MEDICINE IN ENGLAND 
 
 those physicians who were prominent in the cultivation 
 of various branches of science. It has already been 
 stated that the great names of Young, Wells, Wollaston, 
 and Prout form a quartette of physicians who were 
 superlatively great in science. The work of Prout has 
 already been discussed, and attention will now be 
 devoted to the activities of the other three. 
 
 In the van of all those physicians who have con- 
 ferred honour upon our profession by reason of their 
 mental attainments and scientific distinction stands the 
 great name of Thomas Young, the glory of his or, it 
 may be safely asserted, of any other medical age. It is 
 almost impossible to realise the extent and depth of 
 his mental capacity. Physics, Classics, Mathematics, 
 Egyptology, Philology, Music, Biography, and Actu- 
 arial Science, he made them all his own, and to none of 
 them did he devote himself without enriching them 
 with his marvellous knowledge and power of application. 
 Indeed, what Johnson wrote of Goldsmith might with 
 equal truth be applied to Young : " Nihil tetigit quod 
 non ornavit." If any man, however deeply and widely 
 read, will take upon himself a study of the writings of 
 Young, he will rise from his task with a chastened 
 sense of his own inferiority, and will marvel at that com- 
 prehensive mind with its many and clean-cut facets, 
 every one of which represented all that was known of a 
 subject. 
 
 It is impossible for any but experts to follow him 
 through all the particular branches of science and 
 knowledge to which he devoted his powers. But Young 
 has been fortunate in having a biographer who, with the 
 exception of medicine, was qualified to speak with 
 authority concerning all that the subject of his memoir 
 had accomplished. It may, indeed, be doubted if any 
 man of science has been so happily placed as Young in 
 having his life-work described so ably by a natural 
 philosopher who understood so well the difficulties of
 
 DURING THE REIGN OF GEORGE III 57 
 
 the subject. From the purely scientific side of Young's 
 work, Dr. Peacock, his biographer, has given us as com- 
 plete a picture as it is possible to exhibit, and his life 
 of Young, 1 now sadly neglected, is exactly what a 
 record of scientific work should be. It is an eminently 
 just and critical estimate of his hero, unerring, precise, 
 and able. Peacock's one failure was his inability to do 
 justice to the medical side of Young's life. This is by 
 far the weakest part of the book, and it is to be regretted 
 that the chapter dealing with this subject was not en- 
 trusted to one more competent to criticise and pass 
 judgment. 
 
 For a consideration of the work of Young, his life 
 may be divided into three parts : 1. The time devoted 
 to the equipment of his mind, 2. The time in which the 
 results of that equipment were given out, and 3. His 
 medical activities. Everything was to be expected of 
 one who at the age of two years could read with fair 
 fluency, and who at the age of four had read the Bible 
 through twice. With Young there was never any hurry 
 in the acquirement of knowledge ; each subject in turn 
 was taken up and deliberately exhausted before another 
 was attempted. In this way, before he was twenty-one 
 he was entitled to dispute with Person and Parr con- 
 cerning the niceties of Greek composition, and could 
 hold his own in company on any subject. He was 
 fortunate in having for a judicious adviser his uncle, 
 Richard Brocklesby, who not only gave him excellent 
 advice, but by a legacy of 10,000 and his house and its 
 contents in Norfolk Street, Strand, relieved him of the 
 necessity for drudging work in order to obtain a living. 
 Edinburgh, Goettingin, and Cambridge claimed him as 
 a student. In 1802, in his twenty-ninth year, he was 
 appointed to deliver lectures on Natural Philosophy at 
 the Royal Institution, and at about the same time he 
 
 1 "Life of Thomas Young," George Peaccck, 1855. See also 
 Young's " Miscellaneous Works," 3 rols., 1855, edited by Peacock.
 
 58 MEDICINE IN ENGLAND 
 
 published his undulatory theory of light, by which his 
 name will be for ever famous. It was not until 1816, 
 however, that he really began to interest himself in 
 Egyptology. 
 
 In all these branches of science Young was destined 
 to meet with much opposition to his views, and much 
 of his time was spent in answering opponents. Thus, 
 his undulatory theory of light was attacked with ability 
 but unscrupulousness by Brougham, in the " Edinburgh 
 Review," and, largely owing to this attack, the scien- 
 tific world, with the exception of Arago and Fresnel, 
 hesitated for some years to accept his theory. In the 
 domain of Egyptology Young met with even more 
 opposition, and was doomed to see much of his work 
 pilfered by others, of whom the chief offender was the 
 great Champollion. But there can be no doubt now 
 that Young can claim priority over Champollion in the 
 discovery of phonetic hieroglyphics from the study of the 
 Rosetta-stone. 
 
 The opinion may be advanced that Young himself 
 was in part responsible for the persistent endeavours 
 to rob him of the credit for his discoveries. In his 
 writings he too often appears to resent the intrusion of 
 others into the intellectual territory over which his 
 regal mind held sway. He sometimes assumed a tone of 
 superiority, as in the case of his criticism of Dr. Wells' 
 "Essay on Dew," 1 little calculated to soothe. His 
 style was somewhat obscure, and not a little caustic. 
 One almost fears to speak the words, but was Thomas 
 Young entirely guiltless of envy and jealousy ? 
 
 No dispute can arise concerning Young's position in 
 science ; but what can be said regarding his reputation 
 as a physician ? He devoted a large part of his life to 
 the cultivation of the art of medicine, but he acquired 
 no success in practice, and, whether he was waiting 
 for patients in Welbeck Street or at Worthing, one has 
 1 See "Miscellaneous Writings," Young. Vol. II, p. 414.
 
 DURING THE REIGN OF GEORGE III 59 
 
 the feeling that he was engaged in an uncongenial occu- 
 pation, and was chafing at the time thus spent, which 
 might have been employed more profitably. In his 
 two published works, 1 it is, indeed, a laborious Young 
 who writes, but not the Young of science, with his bril- 
 liant deductions and wide conceptions. His " Treatise 
 on Consumptive Diseases " is merely a compilation, 
 and savours too much of having been written to attract 
 those who visited Worthing for the benefit of that 
 complaint. 2 The " Introduction to Medical Literature " 
 displays a vast amount of learning, but in other respects 
 is not remarkable. In fact, it must be admitted that 
 the peculiar character of Young's mind was ill-suited to 
 the study of the art of medicine. Great as he was in 
 the exact sciences, he showed no adaptability when 
 dealing with a subject so inexact as medicine. 3 
 
 At the moral qualities of Young no one can cast a 
 stone. In thought, in deed, in all the relations of life 
 " immaculate " is the only word that can describe him. 
 One almost seeks, as a relief from the invariable recti- 
 tude of his life, some human foible, but there is none. 
 In admiration we gaze at the white marble figure of 
 Young's intellect, perfect in symmetry, and without a 
 flaw. Our only regret is that it lacks warmth. 
 
 But of all the great men of science produced in the 
 reign of George III, Thomas Young rises above them 
 all in mental stature and comprehensiveness of intellect, 
 and the College of Physicians must ever account it a 
 signal honour that it can number him amongst its 
 Fellows. 
 
 1 "An Introduction to Medical Literature," Young, 1813. "A 
 Treatise on Consumptive Diseases," Young, 1815. 
 
 2 It is a matter for astonishment that so great a physicist as Young 
 should speak in slighting terms of Avenbrugger's "Method of Percus- 
 sion." See p. 32 of the ' ' Treatise." 
 
 3 One must not, however, forget that the late Dr. Dickinson gave 
 Young praise, though qualified, as a physician. See " St. George's 
 Hospital Gazette," 1893, p. 77.
 
 60 MEDICINE IN ENGLAND 
 
 Then there is the lonely but commanding figure of 
 William Charles Wells, almost pathetic in its isolation. 
 Success in the shapes of social fame and emolument was 
 not for him. He began his career in London penniless, 
 and after sixteen years of toil was unable to command 
 an income of more than 307 from all sources. Ill- 
 health clogged his steps ; in his forty-third year he 
 was seized with a slight stroke, and henceforth for him 
 it was a grim fight against time to finish the work he 
 had designed. But in spite of these disadvantages he 
 laboured on bravely in his humble lodging in Serjeant's 
 Inn, scarcely known to any but five close friends, and 
 when his work was accomplished he desired only the 
 modest epitaph that " he had tried to extend the 
 boundaries of knowledge." Shrewd judges of mankind, 
 such as Brodie, described Wells as one of the most 
 remarkable intellects of the age, but his peculiar tem- 
 perament and somewhat cold, scientific type of mind 
 did not lend themselves to the showy mental exploits so 
 beloved by the multitude. As evidence, however, of his 
 commanding abilities and personal character it will 
 surely be sufficient to state that he was loved and 
 respected by Matthew Baillie, David Pitcairn, and David 
 Hume. 
 
 In the sphere of Natural Philosophy the name of 
 Wells will be for ever honoured. It was his good fortune 
 to investigate and establish the laws which govern the 
 formation of moisture in the air, and although physical 
 chemistry has advanced in all directions, the funda- 
 mental principles enunciated by him have never been 
 seriously challenged. For this work Wells was awarded 
 the Rumford medal in 1814, and since then his name 
 has been inseparably connected with the subject. 
 
 What was the nature of this experimental work of 
 Wells concerning dew ? Previous to his work it had 
 been supposed, since the days of Aristotle, that dew 
 was formed in the lower atmosphere in consequence of
 
 DURING THE REIGN OF GEORGE III 61 
 
 its moisture being condensed by means of cold, and that 
 in its formation cold was produced. This was the 
 accepted view of Six, Wilson, Prevost, and Wells him- 
 self, after various experiments. On mature reflection, 
 however, Wells became doubtful of the accuracy of 
 this view, and accordingly determined to conduct a 
 series of experiments with the object of testing his 
 theories. These experiments were carried out in the 
 garden of Mr. James Dunsmure, the merchant friend 
 of Wells, who lived in Surrey, three miles from Black- 
 friar's Bridge, and therefore conveniently close for 
 Wells, whose house was in Serjeants' Inn. To this 
 country house Wells betook himself late in the after- 
 noons, and, with varying intervals, caused by ill-health, 
 prosecuted his experimental work during the nights, 
 returning in the early morning to his house for the 
 day's work. In his published "Essay on Dew" 1 he 
 pays an affectionate tribute to his friend Dunsmure 
 for allowing him to use his garden " at considerable 
 inconvenience to the members of the family." Wells 
 also conducted experiments in Lincoln's Inn Fields 
 when increasing infirmity rendered it impossible for 
 him to go into the country. Duns mure' s garden cannot 
 now be located, but Lincoln's Inn Gardens still remain, 
 and are surely hallowed by that association with Wells 
 and his work. 
 
 For his experiments Wells used pieces of wool of 
 known weight, and these he weighed again after they 
 had absorbed the dew in various situations and under 
 varying conditions of atmosphere. He thus became 
 acquainted with the laws which govern the deposition 
 of dew. For instance, he found that the exclusion of 
 the sky from the wool diminished the quantity of dew 
 formed, that more was deposited on wool when on grass 
 than when placed on gravel, mould, bright metals, or 
 when suspended in the air. Having obtained these data, 
 
 1 "An Essay on Dew," Wells, 1814.
 
 62 MEDICINE IN ENGLAND 
 
 he then investigated the part cold played in the forma- 
 tion of dew, and at this stage his original discovery was 
 made. He found, as others had done before, that the 
 temperature of the ground was higher than that of the 
 air above, that passing clouds caused a rise of tempera- 
 ture, and, what was of the utmost importance, that 
 certain substances placed on the ground took on a 
 lower temperature than the ground itself. From these 
 facts he deduced his theory that " Dew is the production 
 of a preceding cold in the substances upon which it 
 appears." He also established the fact that the forma- 
 tion of water from the atmosphere actually produces 
 heat. All this was contrary to the view, hitherto ac- 
 cepted, that dew was formed by the cold of the night, 
 and that in its formation cold was produced. 
 
 Such was the work of Wells. It is a melancholy 
 picture, this last effort of his, feverishly labouring to 
 finish his experiments, with water-logged legs, and the 
 agony of cardiac asthma ever present ; spending nights 
 in Dunsmure's garden which should have been devoted 
 to repose, and then hurrying back to Town in the early 
 morning to write down his results lest death should 
 claim him ere his task was completed. Surely few 
 scientific workers have battled so bravely with adverse 
 conditions. 
 
 The medical work of Wells has not, perhaps, received 
 the consideration it deserves, but a study of it will 
 confirm the opinion that he was a highly original 
 physician. His chief claim to distinction in this sphere 
 rests on the papers he communicated to the Society 
 for the Improvement of Medical and Chirurgical Know- 
 ledge, in which he dealt with the occurrence of albumen 
 in cases of dropsy. His first paper, read on November 
 4th, 1806, 1 related only to cases of dropsy following 
 scarlet fever. This phenomenon had been observed by 
 Plenck, of Vienna, Cruikshank, and Berserius long 
 1 See Vol. Ill, p. 167.
 
 DURING THE REIGN OF GEORGE III 63 
 
 before, but it was Wells who noticed that blood and 
 albumen were present in the urine in these cases. He 
 also established the fact that the dropsy occurred in 
 the upper parts of the body, and described without, 
 however, giving them a name, the ursemic seizures to 
 which such cases are liable. He found evidences of 
 inflammation present in all the abdominal organs, in- 
 cluding the kidneys, and inferred that the process was 
 essentially inflammatory in origin. 
 
 On June 4th, 1811, he read another paper before the 
 same Society, 1 which is marked by his accustomed 
 care and skill in scientific investigation. Here he pointed 
 out that albumen was to be found in cases of dropsy 
 other than scarlatinal, and drew a distinction between 
 hydrothorax, ascites, and dropsy of the skin, in that 
 the two former, if primary, did not have albumen in 
 the urine. This was the first attempt to differentiate 
 between the various forms of dropsy. The point was 
 used with great advantage by Blackall, 2 who, writing 
 two years later, still further elaborated it, but the 
 merit of pointing it out belongs to Wells alone. In 
 support of his contentions Wells quoted two post- 
 mortem examinations, in one of which " the kidneys 
 were much harder than they usually are, and the 
 cortical parts were thickened," while in the other he 
 says " the kidneys were larger and softer, and on the 
 outside were several vesicles." He gave the credit of 
 the discovery of albumen to Cruikshank, who men- 
 tioned it in 1798, but points out that he had discovered 
 it independently in 1799. Wells had, therefore, estab- 
 lished the fact of albumen in dropsy. He had differ- 
 entiated the forms of dropsy in which albumen is 
 found. He had even indicated that the kidneys were 
 diseased, but he failed to point out the causal relation- 
 
 1 See Vol. Ill, p. 194. 
 
 1 "Observations on the Nature and Cure of Dropsies,' 1 Blackall, 
 1813.
 
 64 MEDICINE IN ENGLAND 
 
 ship between the two. This momentous clinical fact 
 had to await the advent of Richard Bright, but it was 
 Wells who prepared the ground. 
 
 To complete the consideration of the work of Wells 
 it must be remembered that Darwin himself, in his 
 historical introduction to the " Origin of Species," 
 gives to Wells the credit of having been the first to 
 enunciate the principle of natural selection, in a paper 
 read before the Royal Society in 1813. Surely this is 
 the most precious jewel in his scientific crown. 
 
 Wells was an excellent classic, and wrote Latin with 
 ease and correctness. In the literature of his own 
 tongue he was widely read, and as a writer of vigorous 
 and even elegant English it may be doubted whether 
 he had a superior in the medical profession. While on 
 his death-bed he dictated an autobiography l to his 
 friend Mr. Patrick which is worthy of perusal as an 
 honest and fearless estimation of his character and 
 work. Altogether, Wells was one of the great men of 
 our profession during the reign of George III ; a man 
 of great scientific ability, with a lofty conception of 
 duty, and with an adherence to truth which never 
 swerved. 
 
 William Hyde Wollaston was so little associated with 
 the practice of medicine that his work can scarcely be 
 considered from that point of view. Very early in his 
 career he definitely severed his connection with medi- 
 cine, owing, it is said, to his unsuccessful application 
 for the post of physician to St. George's, and henceforth 
 devoted himself entirely to science. Some of his scien- 
 tific worki however, related to problems in medicine, 
 and in this field he initiated enquiry which led to im- 
 portant results. He was one of the first to study the 
 composition of calculi, and other abnormal constituents 
 of the urine ; work which, no doubt, paved the way for 
 
 1 This interesting autobiographical sketch is prefixed to the posthu- 
 mous edition of the " Works of Dr. Wells," issued in 1818.
 
 DURING THE REIGN OF GEORGE III 65 
 
 the further extension of the subject by Prout and 
 Marcet. He also explained the phenomenon of hemian- 
 opia, and demonstrated the partial decussation of the 
 fibres in the optic commisure. But, with these excep- 
 tions, the whole of the scientific work of Wollaston 
 belonged to Physics, Chemistry, and Metallurgy. He 
 discovered Rhodium and Palladium, and devised a 
 process for rendering Platinum malleable. He was the 
 first to see the dark lines in the spectrum, since known 
 under the name of Fraunhofer's Lines, but failed to 
 appreciate their true significance. As a point of peculiar 
 interest at the present time, it may be mentioned that 
 Wollaston invented the periscope, an instrument so 
 frequently in our thoughts to-day. 
 
 Excessively cautious, fearing to advance by bold 
 deductions, Wollaston constantly allowed others to 
 reap where he had sown. In this way he lost his claim 
 to be one of the first sponsors of the Atomic Theory, and 
 the judgment passed on him by Dr. Peacock, to the 
 effect that on account of these failings his name is un- 
 connected with great epochal advances is eminently 
 correct. 1 It should, however, be mentioned that 
 Wollaston shares with Sir Hans Sloane and Sir John 
 Pringle the honour of being one of the three Fellows of 
 the College who have reached the dignity of the Presi- 
 dential chair of the Royal Society. 
 
 We have now completed the sketch of the progress 
 made in medical knowledge during the reign of George 
 III. We have seen that soon after the beginning of the 
 reign a distinct revival of activity in its study became 
 evident. We have shown that, at first, the revival 
 manifested itself in an increase of clinical knowledge 
 gained almost entirely from observation of symptoms 
 during illness. We have pointed out the manner in 
 which the obstacles to the advance of clinical medicine 
 
 1 See " Life of Thomas Young," by Geo. Peacock, 1855, p. 469, quoted 
 also by Munk, " Roll of the College."
 
 66 MEDICINE IN ENGLAND 
 
 were surmounted by the application of the sciences of 
 pathology, physiology, and chemistry, which, towards 
 the end of the eighteenth century, had been placed 
 upon a sound foundation. We have also devoted space 
 to the consideration of those physicians whose activities 
 were mainly scientific. In all this the main features of 
 the spirit of the eighteenth century, which laboured 
 unceasingly for the emancipation of the human in- 
 tellect, for freedom of thought, and for enquiry on 
 scientific lines, can be clearly observed. We owe to the 
 physicians of the age of George III an immense debt 
 for the excellent foundations they built, often with 
 rough and improvised tools. Like the Georgian archi- 
 tecture, the Georgian silver, and the Georgian glass, 
 they were large and solid, and were fashioned to stand 
 the test of time. Men of the stamp of Hunter, Baillie, 
 Prout, and Willan flung open the portals of medical 
 science, through which their descendants have passed 
 to realms of spacious and accurate knowledge.
 
 CHAPTER III 
 
 MEDICINE IN RELATION TO THE STATE 
 
 Lunacy Prisons Vaccination Public Health The Army Medical Ser- 
 vice The Walcheren Expedition. 
 
 IN order to complete the review of the state of medicine 
 in England during the reign of George III, it will be 
 necessary to consider at some length the large subject 
 of medicine in relation to the State at that period. 
 This will involve an enquiry concerning the principles 
 of medical treatment of the insane, prisoners, and 
 paupers ; the rise and effects of vaccination ; the in- 
 ception of sanitary science, and the development of the 
 medical services in the Navy and Army. The study of 
 these special branches of medicine is important, for 
 during the reign of George III the principles which 
 govern their practice at the present day were formu- 
 lated and instituted. Since that time, although many 
 changes in detail have occurred, the framework built 
 in those days has undergone but little alteration. 
 
 LUNACY AND MADHOUSES 
 
 In no department of medicine during the reign of 
 George III was the spirit of improvement at a lower 
 ebb than in that of the care and treatment of the 
 insane. It appeared to be the settled conviction of 
 alienists that the principles of the treatment of mad 
 people were satisfied by locking them up securely and 
 by curbing their obliquities by means of barbarous 
 coercion, and other cruel repressive measures. Men at 
 the head of this particular branch of medicine seemed 
 
 67i
 
 68 
 
 to be content with these methods. For instance, PF. 
 Monro, the able superintendent of Bethlem, when 
 before the House of Commons Committee, apparently 
 regarded it as nothing unusual that a patient under his 
 care at Bethlem had been for nine years with iron 
 collars round his neck and waist, and fettered to the 
 wall with heavy chains. His only justification for such 
 a proceeding was that the patient was " one of the most 
 mischievous and ferocious lunatics he had ever known." 1 
 But while the majority of alienists held these views 
 an exception must be made in the case of Dr. Battie, 
 who was physician to St. Luke's. In this institution, 
 under his influence, coercion had always been tempered 
 with some show of kindness, and Dr. Rawes, the late 
 superintendent, has said that many of the rules and 
 regulations framed by Battie 150 years ago require but 
 little alteration at the present day. 
 
 To appreciate the whole squalid story of the manner 
 in which the insane were cared for and treated in the 
 reign of George III, it is necessary to read the evidence 
 given before the Committee of the House of Commons 
 in the years 1813-15. That evidence recounts such acts 
 of cruelty and callous negligence that go far beyond the 
 wildest flights of the imagination of the uninstructed 
 writer of romance. These poor creatures were beaten, 
 starved, and manacled for acts over which they had no 
 control. For months at a time they were cast into 
 filthy dungeons with no light or clothing, and with only 
 excrement-sodden straw on which to lie. Amputations 
 of the fingers and toes, on account of frost-bite, were by 
 no means uncommon. The practice of feeding by force 
 was often resorted to, not on account of refusal to take 
 food, but as a punishment, and from the barbarous 
 
 1 Nearly the whole of this account of the condition of lunatics has 
 been taken from the evidence given before the House of Commons 
 Committee during the years 1813, 14, and 15. See "Parliamentary 
 Papers " under the heading " Madhouses."
 
 DURING THE REIGN OF GEORGE III 69 
 
 method employed death from suffocation was often the 
 result. It rested with the keepers of the madhouse to 
 decide whether an enquiry before a coroner should take 
 place in case of sudden death, and it was given in 
 evidence that the jurors were often chosen by the 
 keeper. Nearly all the madhouses in London, of which 
 there were thirty-seven, were managed by people who 
 had been keepers in similar institutions, and an apothe- 
 cary was called in to attend those who were sick. Rank 
 of patients procured no amelioration of their wretched 
 state. A captain of the Guards was beaten by a keeper 
 so severely that he died, and a colonel was confined in 
 a cell for several months naked, with nothing but dirty 
 straw for a bed. A smith in London Wall prospered in 
 his business on account of his special skill in forging 
 fetters and chains for the hapless lunatic. If the 
 madman made a noise he was gagged. In many places 
 rats swarmed, and one witness swore that he had seen 
 a patient call by name from their holes forty rats that 
 she had tamed. Rat bites were common, and vermin 
 infested the cells. No attempt at medical treatment of 
 the insane was made, and the physicians appointed to 
 inspect these places did their work in the most per- 
 functory manner. Violent patients were bled until 
 they became exhausted, and acts of immorality some- 
 times took place between the keepers and the female 
 patients. In fact, when one reads the evidence before 
 this Committee of the revelations of Mrs. Humieres, of 
 the iniquities of Rambaud and Dowding, and of the 
 horrors of " Bella's Hole," a feeling of unreality seizes 
 the mind. 
 
 It is sad to have to record the fact that it was not 
 from the medical profession that any suggestion of 
 improvement came, but from several noble-minded 
 legislators, of whom the names of Townshend, Rose, 
 Lord Robert Seymour, and Lord Binning will ever be 
 remembered. The first attempt at legislation came in
 
 70 
 
 February, 1763, when Mr. Townshend presented to the 
 House of Commons a report on the condition of mad- 
 houses. 1 From this report it was evident that the con- 
 dition of these places was very bad, and that the 
 lunatics were admitted to them in a very loose manner. 
 No real inspection ever took place, and the keepers 
 were in the habit of admitting patients on the simple 
 request of their relatives. In many instances those 
 admitted were perfectly sane, and were incarcerated 
 for nefarious purposes. As a result, regulations were 
 framed for the better conduct of the madhouses, but 
 in 1773 Mr. Townshend again brought up the subject, 
 and placed the report of 1763 before the House. A bill 
 was then introduced and passed in the following year, 
 by which the inspection of madhouses was placed in 
 the hands of visitors appointed by the College of 
 Physicians. By this Act, five Commissioners were to 
 be elected annually by the College, three of whom, with 
 a secretary, were to be required to visit once a year 
 every madhouse in London and seven miles around, 
 and for this work they were to receive a guinea each for 
 every madhouse visited. The powers of the Com- 
 missioners were, however, limited, for although they 
 were able to withdraw a licence, the magistrates had 
 no power to refuse a regrant, provided sufficient security 
 was forthcoming. 
 
 Under this arrangement the condition of madhouses 
 showed no tendency to improve, and it must be ad- 
 mitted that the Commissioners expended little time 
 and trouble in the performance of their duties. 2 Very 
 soon a strong feeling arose that the treatment of lunatics 
 was a reproach to the country, and that the time was 
 
 1 For a full account of this Report see "Parliamentary History," 
 Vol. XV. (Report re Madhouses, 1763.) 
 
 1 It was given in evidence before the Committee, that a Commissioner 
 visited a house in Hoxton and claimed to have examined 405 inmates in 
 two and a half hours.
 
 DURING THE REIGN OF GEORGE III 71 
 
 ripe for a movement in the direction of the ameliora- 
 tion of their unhappy condition. There were several 
 reasons for this change of opinion. The Draconian age 
 of legislation was passing away ; the teaching of Pinel, 
 which was the antithesis of force in the treatment of 
 the insane, was beginning to be known in England, 
 and, under the influence of the Tukes, the Retreat at 
 York had been opened, where methods of kindness 
 and persuasion took the place of cruelty and repression. 
 Finally, to these causes must be added the repeated 
 attacks of insanity from which George III himself 
 suffered, and which impressed the subject upon the 
 minds of legislators. The result of these conditions was 
 the Select Committee of the House of Commons in 
 1813, to which reference has already been made. On 
 June 17th, 1816, a bill was promoted, by which it was 
 intended to repeal the Act of 1774 and to appoint eight 
 Commissioners, under the jurisdiction of the Home 
 Secretary, who, with the assistance of two magistrates, 
 were to be responsible for the care of all madhouses. 1 
 This bill, however, failed to become law, and it was not 
 until some years later that legal effect was given to the 
 findings of the Select Committee. But the conscience 
 of the nation had been awakened, and afterwards, 
 largely owing to the great work of Connolly, the foul 
 stain of our horrible treatment of the insane was re- 
 moved from the annals of the country. 
 
 The physicians chiefly responsible for the care of 
 lunatics during the reign of George III were William 
 Battie, Thomas Brooke, Samuel Foart Simmons, and 
 A. R. Sutherland, all of whom were physicians to St. 
 Luke's. Three generations of the family of Monro, 
 
 1 See an interesting speech on June 17th, 1816, by Lord Robert 
 Seymour regarding the condition of madhouses. Hansard, 1816. Also 
 "The Pamphleteer,' Vol. VI, for the findings of the Committee on 
 Madhouses. The whole subject, however, should be read in the evidence 
 published in " Parliamentary Papers " Select Committee of House of 
 Commons on Madhouses, 1813-16.
 
 72 MEDICINE IN ENGLAND 
 
 viz. James, Thomas, and Edward, held sway at Bethlem, 
 and to these must be added Dr. Francis Willis, D.D. 
 and M.D., at one time vicar at Wapping, but famous 
 as the physician in attendance upon the King. In 
 addition to occupying these positions, they were all 
 interested in private houses for the insane, out of which 
 they accumulated large fortunes. They do not, how- 
 ever, appear to have contributed much to the advance- 
 ment of their speciality. 
 
 PRISONS 
 
 The sanitary condition of prisons was scarcely less 
 deplorable than that of madhouses during the reign 
 of George III, and was hardly considered to be a subject 
 requiring reform by even the most enlightened publicists. 
 Nor will this attitude cause astonishment when it is 
 remembered that legislation occupied itself solely with 
 punishment for misdeeds, and took no account of pre- 
 vention of crime by elevating the moral tone of the 
 criminal. The medical care of prisons was in the hands 
 of apothecaries. No regular attendance was required, 
 and it was left to the governor of the prison to determine 
 whether the visit of the apothecary was desirable. 1 
 Even in the cases of the large debtor prisons, the 
 " King's Bench," the " Marshalsea," and the " Fleet," 
 no medical man was appointed, and the inmates were 
 dependent upon the good offices of some medical 
 debtor prisoner for treatment when sick. The in- 
 sanitary condition of these prisons was terrible, and 
 such hotbeds of vice and disease were they that the 
 assistant-master of the " Fleet," in his evidence before 
 the Parliamentary Committee, shamelessly described 
 his prison as the largest brothel in London. 2 The jails 
 
 1 See " History of Medicine," John Mason Good, 1796. 
 
 8 See " Report of the Parliamentary Committee on the ' King's 
 Bench,' ' Marshalsea,' and Fleet Prisons,' " 1814. The evidence before 
 this Committee is also published in "The Pamphleteer," Vol. VI.
 
 DURING THE REIGN OF GEORGE III 73 
 
 were veritable forcing-houses for typhus and other 
 contagious complaints, and many of the great epidemics 
 could be traced to these places. The work of John 
 Howard contributed much to the improvement of 
 sanitary conditions in the prisons, but for a long time 
 little real progress was made. The Poor Law, also, 
 was administered with scarcely any regard for the 
 medical care of the paupers, whose lot was most un- 
 fortunate. They were left to the care of the " Master " 
 of the workhouse, and, when ill, it was his province to 
 decide whether medical aid was necessary. 
 
 VACCINATION 
 
 In 1798 Edward Jenner published his " Enquiry 
 into the Causes and Effects of Variolae Vaccinae," and 
 thus established his claim to be the first to advocate 
 vaccination as a preventive of small-pox. He was not 
 the first, however, to practise this method, for Benjamin 
 Jesty, a farmer in Dorset, had previously, in 1774, 
 vaccinated some of the members of his family. It is 
 not, however, proposed to proceed here upon the well- 
 beaten track of the history of the discovery of vacci- 
 nation by Edward Jenner. That subject has been 
 already exhausted by many able authorities, and 
 especially by Professor Crookshank, whose notable 
 book is in truth the last word on the question. 1 The 
 struggle for the supremacy of vaccination which took 
 place in the early years of its history may, however, be 
 briefly described. 
 
 In its inception, vaccination, like every other revolu- 
 tionary medical advance, was compelled to fight for its 
 existence. For eighty years inoculation had been the 
 recognised method for protection from small-pox, and 
 in the hands of the Suttons and Dimsdale it had become 
 
 1 " History and Pathology of Vaccination," 2 vols. Crookshank, 
 1889. This work is valuable to the student on account of the reprints of 
 many papers connected with the early history of vaticination.
 
 74 MEDICINE IN ENGLAND 
 
 as safe in its operation as such a dangerous procedure 
 could be. Vaccination, on the other hand, was new ; 
 its exact mode of action was imperfectly understood, 
 and it was necessary to rid it of avoidable accidents 
 before it could be accepted as superior to inoculation. 
 It has been the custom to visit with unusual censure 
 the action of Benjamin Moseley, William Rowley, 
 George Lipscombe, John Birch, 1 and others in their 
 opposition to vaccination. As reactionaries, no doubt, 
 they merited a measure of blame, but the rancour dis- 
 played by them was repaid with interest by the sup- 
 porters of the newer method, and it cannot be denied 
 that they had some ground for their opposition. But 
 in no long time vaccination triumphed over all obstacles, 
 the weaker supports of its theory were replaced, proof 
 of its efficacy became overwhelming, and one of the 
 richest blessings was conferred upon suffering man- 
 kind. 
 
 The great name of Jenner deservedly overshadows 
 all others connected with the movement, and we are 
 apt to forget the meritorious labours of his associates. 
 George Pearson and William Woodville 2 at once cham- 
 pioned the new method, and submitted it to extensive 
 tests. Woodville, on account of the position he held 
 of physician to the small-pox hospital, was able to 
 conduct his experiments under most favourable cir- 
 cumstances, and it may be doubted whether vaccina- 
 tion would have made such rapid progress without his 
 valuable co-operation. 
 
 1 In order to appreciate the position of the Georgian anti-vaccination- 
 ists, the following tracts should be read: "Treatise on Lues Bovilla," 
 B. Moseley, 1805. "Cow-Pox Inoculation," William Rowley, 1805. 
 " Manual of Inoculation," George Lipscombe, 1806. " Reasons for 
 Objecting to Vaccination," John Birch, 1806. These tracts, of course, 
 seem puerile at the present day, but were formidable in the early years 
 of the eighteenth century. 
 
 2 See "An Enquiry Concerning the History of Cow- Pox," George 
 Pearson, 1798. " Reports of a Series of Inoculations for the Variolse 
 Vacinee or Cow-Pox," Woodville, 1799.
 
 DURING THE REIGN OF GEORGE III 75 
 
 PUBLIC HEALTH 
 
 During the greater part of the reign of George III, 
 such efforts as were directed towards the improvement 
 of public health were made by private individuals, for 
 no authority existed for this purpose. When epidemics 
 of unusual severity took place, the matter was often 
 referred to the College or to physicians who were 
 authorities on the subject. A report was then drawn 
 up and appropriate measures were instituted to combat 
 the condition. Several physicians, however, made the 
 incidence of disease in the metropolis then* especial 
 study, among whom must be mentioned the names of 
 Heberden, Reid, Willan, Blane, and Bateman. Willan 
 may be said to have been the first physician to make a 
 systematic study of the health conditions of London, 
 and in 1796 he began his " Monthly Reports on the 
 Diseases of London," which were originally published 
 in the " Monthly Magazine," but were afterwards 
 collected in one volume in 1800. In 1805 Pitt made 
 the first attempt to establish State control of public 
 health when he brought into being his " Board of 
 Health," but after a brief existence of a few months it 
 was abolished in the following year. Some years later 
 another Board was set up, and on this the College of 
 Physicians was well represented. The subject of Public 
 Health, however, was not seriously considered by the 
 State until after the work of Southwood Smith and 
 George Birkbeck had awakened the conscience of the 
 nation, but the efforts of these two great pioneers 
 belong to a later period, and do not properly fall within 
 the scope of these chapters. 
 
 THE ARMY MEDICAL SERVICE 
 
 Vast changes took place in the Army Medical Service 
 during the reign of George III, and it becomes important 
 to study them with attention, for they often afford an
 
 76 MEDICINE IN ENGLAND 
 
 explanation of the various stages through which the 
 service passed until its permanent foundations were 
 laid. 
 
 The early history of the Army Medical Service is 
 somewhat obscure and difficult to follow with any 
 accuracy, but the germ of the system is to be found, at 
 any rate so far as regards its control, in the practice 
 which obtained from early times of appointing a 
 physician, and sometimes a surgeon, to accompany the 
 monarch or the commander-in-chief when he went to 
 the war. 1 Naturally, they were appealed to by the 
 commander in any medical difficulty that arose, and 
 soon, in addition to being responsible for the health of 
 the head of the Army, they were entrusted with the 
 care of the health of the Army as well. During the 
 Civil War a serious attempt appears to have been 
 made to place the medical department of the Army 
 under proper supervision, and to this end the Parlia- 
 ment ordered three physicians, one of whom was Paul 
 de Laune, to be attached to the Army under the com- 
 mand of the Earl of Essex. The commission lists of 
 the Cavaliers and the Roundheads 2 also show that to 
 each regiment a regular surgeon was attached. In 
 1649 a further step was taken, and Jonathan Goddard 
 was appointed by Cromwell to the post of " First 
 Physician " to the Army. In this capacity Goddard 
 accompanied Cromwell to Scotland and Ireland, where 
 he was succeeded by Sir William Petty in 1752. 3 The 
 position of a single medical head in supreme authority 
 over medical matters in the Army was thus established, 
 and in much the same way a surgeon came to exercise 
 
 1 Thomas Muffett, a Fellow of the College of Physicians was probably 
 the first to be appointed Physician to an Army, when he was attached 
 to the Expedition to Normandy, under the Earl of Essex in 1591. 
 
 2 See Peacock's " Lists of the Cavaliers and the Roundheads. " 
 
 3 See " Munk's Roll," Vol. I, under Goddard, Petty, and De Laune. 
 Also Dalton's " English Army Lists," and Johnstone's " Roll of the 
 Army Medical Service."
 
 DURING THE REIGN OF GEORGE III 77 
 
 supervision over surgeons and their duties. At first, 
 these chief physicians and surgeons held their appoint- 
 ments only during the progress of a war, but in 1660, 
 when a standing army was authorised, a Physician- 
 General and a Surgeon-General were appointed, who 
 exercised authority continuously during peace and war. 
 The first Physician-General to be appointed was Thomas 
 Laurence in 1685, and the first Surgeon-General was 
 John Knight, appointed in 1664-. Physicians and 
 Surgeons-General were also appointed for Scotland and 
 Ireland, and from 1660 until 1756 little material change 
 was made in the method of government of the medical 
 department in the Army. 
 
 According to Richard Brocklesby, 1 the first attempt 
 to form an Army Medical Board of Control was made 
 in 1756 by the Duke of Cumberland, who desired 
 Viscount Barrington, Secretary of State at War, to 
 establish a Hospital Board for the Army. This Board 
 was composed of the Physician-General, the Surgeon- 
 General, the physicians to hospitals, the Principal 
 Surgeon of Hospitals, and the Purveyor-General, who 
 were ordered to consult together concerning hospital 
 matters. This Board recommended that the physicians 
 should examine, superintend, and control the hospital 
 mates, but that the surgeons should be allowed to 
 nominate mates for their own department. Much was 
 expected from the deliberations of the Board, and had 
 time allowed, no doubt, many salutary reforms would 
 have been instituted. But the career of the Board 
 was suddenly cut short by the outbreak of war, when 
 the physicians to hospitals and most of the surgeons 
 were sent abroad, and the Principal Hospital Surgeon, 
 after having been appointed Inspector of Regimental 
 Infirmaries, gradually assumed all the functions of the 
 
 1 See "Economical and Medical Observations from 1758 to 1762, 
 Tending to the Improvement of Military Hospitals," Brocklesby, 1764, 
 p. 31.
 
 78 MEDICINE IN ENGLAND 
 
 Board. He appointed all the hospital mates and ac- 
 cepted the examination at the Surgeon's Hall as a test 
 of fitness. The Board, therefore, virtually ceased to 
 exist, and was not revived again until 1793. 
 
 During the early part of the reign of George III, the 
 post of Physician-General was held successively by 
 Sir Edward Wilmot and Sir Clifton Wintringham, who 
 owed their appointments respectively to George II and 
 the Duke of Cumberland. The combined posts of 
 Surgeon-General and Inspector of Regimental Infirm- 
 aries was held, first by Mr. Adair, and afterwards by 
 the great John Hunter. 1 On Hunter's death in 1793 
 the two appointments held by him were separated, and 
 two of his surgical colleagues at St. George's, Mr. 
 Gunning and Thomas Keate, were appointed respec- 
 tively Surgeon-General and Inspector of Regimental 
 Infirmaries. At this time it was apparently felt that 
 the supreme direction of medical matters in the Army 
 required some co-ordination, for Wintringham was in 
 his eighty-third year, and incapacitated by infirmities 
 from attending to business. Gunning and Keate were 
 accordingly instructed to consult together regarding all 
 Army medical affairs, including the appointment of 
 physicians, surgeons, and hospital mates. In this 
 manner the Army Medical Board was reconstituted. 
 On January 15th, 1794, after the death of Wintring- 
 ham, Sir Lucas Pepys was appointed Physician-General 
 as a reward for services rendered to the King during his 
 illness in 1789. Pepys had no special knowledge of the 
 conditions and requirements of the Army Medical 
 Service. He had never served in the Army, and much 
 will be said hereafter concerning his influence during 
 the fifteen years he occupied this position. From 1794 
 to 1798 the three members of the Board performed 
 
 1 Sir Edward Wilmot held this position from 1740 to 1787, and Sir 
 Clifton Wintringham from 1787 to 1794. Hunter held his posts for three 
 years, although he had been Deputy Surgeon-General for several years.
 
 DURING THE REIGN OF GEORGE III 79 
 
 their functions in a collective capacity, and although 
 they each had their special departments, the Board as 
 a whole was responsible to the Commander-in-Chief for 
 the acts of each member. 
 
 In 1798 Gunning died, and his position of Surgeon- 
 General was assumed by Keate, while Mr. Rush was ap- 
 pointed Inspector of Regimental Infirmaries in place of 
 Keate. Rush died in 1801, and was succeeded by 
 Francis Knight, that appointment being now styled 
 Inspector-General of Hospitals. On March 12th, 1798, 
 a new order regarding the Army Medical Board was 
 issued by the Commander-in-Chief, by which many of 
 its collective functions were abrogated, and each 
 member was made, more or less, supreme in his own 
 department. 
 
 The precise functions of each member of the Board, 
 as it now existed, will be found in the " Report of the 
 Commissioners for Military Enquiry for 1808," * and 
 in the evidence given by the members of the Board 
 before the House of Commons in 1810, regarding the 
 Walcheren Expedition. 2 Surely it is impossible to 
 imagine a more clumsy and impossible arrangement. 
 Even after a patient study of these documents it is a 
 most difficult matter to determine the functions of the 
 Board in either its individual or collective capacity. 
 The position, so far as can be ascertained, was as 
 follows : Collectively the Board was supposed to 
 meet if questions were submitted to it. It was to obey 
 orders, but it was no part of its business to make repre- 
 sentations, and when it did meet the Physician-General 
 took the chair. In their individual capacities the 
 members were assigned special duties, but the conduct 
 
 1 In this account of the Array Medical Board, the information found 
 in the evidence given before the Commissioners for Military Enquiry in 
 1808 has been used. The Fifth Report of the Commissioners is a mine 
 of knowledge concerning medical affairs in the Army. 
 
 a See "Walcheren Expedition, Evidence." Hansard, Vol. XV, 1810.
 
 80 MEDICINE IN ENGLAND 
 
 of these duties could not be brought under the criticism 
 of the Board as a whole. The Physician-General, with 
 a salary of 40s. per diem, was responsible for the choice 
 of physicians, for the supervision of medical drugs, and 
 for the examination of candidates for the posts of 
 physician in the Army. The Surgeon-General, with a 
 salary of 40s. per diem, and also an extra 800 per 
 annum as the holder of the sinecure post of surgeon to 
 Chelsea Hospital, appointed the surgeons for the Army 
 and provided surgical drugs and appliances. He occu- 
 pied a seat on the Court of Examiners at the College of 
 Surgeons for granting a certificate to hospital mates. 
 He consulted with the authorities on medical matters 
 while the troops were on foreign service, and he received 
 the returns of sick and wounded. The Inspector-General 
 was entrusted with the duties of providing Inspectors 
 of hospitals and hospital mates. He had charge of 
 regimental hospitals, and held the position of surgeon 
 to the staff of the Commander-in-Chief. In addition to 
 his salary of 40s. a day, he received an equivalent 
 amount on account of his position of Controller of 
 Army Hospital Accounts. Finally, he was responsible 
 for the provision of drugs for the Guards regiments, and 
 superintended the education of cadets for hospital 
 mates. To complete the description of this edifice of 
 inconsistencies, it remains to be said that the Guards 
 chose their own surgeons, that the medical department 
 of the Ordnance was a separate concern under the 
 control of an Inspector-General, and that the medical 
 comforts were under the control of the Commissary- 
 General. Finally, all the members of the Board were 
 engaged in active private practice. 
 
 Such was the state of the Army Medical Board after 
 its duties had been defined in 1798. Had unanimity 
 prevailed, and had machinery existed whereby the 
 Board as a whole could assume authority over its 
 separate departments, it might have been possible to
 
 DURING THE REIGN OF GEORGE III 81 
 
 render the system workable. Unfortunately, however, 
 jealousy reigned, quarrels were of frequent occurrence, 
 and its state could only be described as chaotic. But, 
 in spite of all the manifest imperfections of the Board, 
 one great principle was instituted. The medical exam- 
 ination of all candidates was obligatory, although in 
 the case of surgeons it was only the easy pass examina- 
 tion framed by the Corporation of Surgeons for hospital 
 mates. 
 
 The Army Medical Board, therefore, proved to be 
 unworkable, and contained in its system the seeds of 
 death which eventually caused its destruction. Some 
 of its faults may be noticed. The Surgeon-General 
 appointed the regimental surgeons, but the class from 
 which they were chosen, the hospital mates, was under 
 the special authority of the Inspector-General. The 
 Inspectors of Hospitals, who were in a position of 
 superior authority to the regimental surgeons, were 
 appointed by the Inspector-General, while the physicians 
 who held a higher rank than the surgeons, w r ere chosen 
 by the Physician-General, and were placed under the 
 Inspectors. 
 
 The hospital system in the Army Medical Depart- 
 ment was also a cause of much trouble and jealousy. 
 Originally each regiment had a regimental hospital, 
 under the care of the surgeons, but the Board instituted 
 general hospitals, which were largely staffed by phy- 
 sicians, and the regimental hospitals were depleted in 
 order to fill the general hospitals. Owing, it was claimed, 
 to the want of military medical experience of physicians, 
 the patients were not so well treated as in the regimental 
 hospitals. This battle of the hospitals continued for 
 many years, the chief combatants being the Inspector- 
 General, Mr. Knight, with his lieutenants, Dr. Borland, 
 James McGrigor, Robert Jackson, and Young, on behalf 
 of the regimental hospitals, while the Physician-General 
 and the Surgeon-General enlisted the able services of
 
 82 MEDICINE IN ENGLAND 
 
 Dr. E. N. Bancroft on the side of the general 
 hospitals. 1 
 
 The method adopted by Sir Lucas Pepys, the Phy- 
 sician-General, in appointing physicians, also, caused 
 much discontent in the Army Medical Department. 
 When Sir Lucas assumed control, he at once established 
 the rule that he would appoint as physicians only those 
 who were Licentiates of the College. He followed this 
 plan in defiance of the expressly worded order of the 
 Commander-in-Chief, issued in 1798, which said, " for 
 physicians, a medical degree in an English University 
 or a licence from the College of Physicians, although 
 desirable, must not be considered indispensable." 
 Scarcely any medical men already in the Army held the 
 licence, and consequently the superior posts of physician 
 were given to men who had no previous connection with 
 the Army. Staff surgeons and regimental surgeons, 
 however able, were entirely shut out. Sir Lucas when 
 asked, in his examination before the Commissioners of 
 Military Enquiry, why he adopted this method, could 
 only answer that he regarded a knowledge of the prin- 
 ciples of medicine as of more importance than special 
 knowledge of Army medical matters. In all, during 
 his occupancy of the post of Physician-General, he had 
 appointed fourteen physicians, not one of whom had 
 ever served in the Army before. In some cases real in- 
 justice was done and the efficiency of the service im- 
 perilled. 2 The case of Dr. Wright was an example. 
 This physician had practised for seventeen years in the 
 West Indies, and had paid particular attention to 
 diseases incident to that climate. His scientific attain- 
 ments were of a high order, and when the expedition 
 under Sir Ralph Abercromby was fitting out Sir Ralph 
 
 1 See for this movement "Parliamentary Papers," Vol. XIV, 1810. Vols. 
 12, 13, 16, 20, 21, 25, and 27 of the War Office Series in the PublicReconl 
 Office (W.0. 40) also deal with Reform in the Array Medical Department. 
 
 2 See the evidence of Sir Lucas Pepys " Fifth Report of Commissioners 
 for Military Enquiry, 1808. '
 
 DURING THE REIGN OF GEORGE III 83 
 
 was anxious to secure his services, but Sir Lucas re- 
 fused to appoint him unless he held the licentiate of the 
 College. He even went so far as to say that he felt sure 
 the King would refuse to sign his commission without 
 his recommendation. He indicated another gentleman 
 who held the licence, but who had no experience of 
 practical medicine. Sir Ralph was, however, insistent, 
 and Dr. Wright was appointed over the head of the 
 Physician-General. 1 
 
 As the result of all these causes of complaint the 
 Commissioners of Military Enquiry investigated in 1808 
 the manner in which the Army Medical Board was per- 
 forming its functions, and their exhaustive report was 
 responsible for the thorough reorganisation of the Army 
 Medical Service and the inauguration of an era of in- 
 creased efficiency. In this Fifth Report the Com- 
 missioners state that, so far as they can ascertain, the 
 condition of the Army Medical Service had never been 
 the subject of enquiry before. They investigated the 
 whole working of the service, they examined on oath all 
 connected with it, and in the end summed up their 
 conclusions in a masterly report which covered eighty 
 pages. They advised a reconstruction of the Board, so 
 that in future it should be a consultative body with a 
 supreme head assisted by a certain number of other 
 individuals. They pointed out the injustice of the 
 manner of selection for various medical posts, and 
 indicated the way in which this selection should be 
 conducted. Finally they took exception to the loose 
 manner in which the members of the Board had super- 
 vised the contracts for drugs and appliances, and re- 
 commended the employment of some person skilled in 
 accounts to check them. 
 
 When the Report was published it brought forth long 
 letters from Keate, the Surgeon-General, in justification 
 of his conduct, in which he indulged in recriminations 
 1 See " Letter to Lord Kenyon," Wells, p. 107.
 
 84 MEDICINE IN ENGLAND 
 
 against Knight, Borland, and McGrigor. He imputed 
 to Knight the desire to encroach upon his special depart- 
 ment, and want of ability in the management of his own. 
 The quarrel between Knight and Keate was already 
 acute enough, and these letters only served to accentu- 
 ate the difference still further, with the result that 
 Knight refused to meet the Physician-General and the 
 Surgeon-General. 1 With this state of affairs existing, 
 the Walcheren Expedition took place and emphasised 
 more pointedly than ever the need for reform. 
 
 In November, 1809, the Secretary at War appointed 
 a Committee composed of Generals Trigge, De Lancey, 
 Brownrigg, Calvert, and Colonel Gordon to take into 
 consideration the Report of the Commissioners for 
 Military Enquiry and to give effect to their recom- 
 mendations. The Committee met on November 28th, 
 and succeeding days, and advised the following changes : 
 1. That the medical department of the Army should be 
 presided over by a single head, to be called the Director- 
 General, with a salary of 2000 a year. 2. That two 
 others, to be called Principal Inspectors, should be 
 associated with the Director-General in the control of 
 the Department, with a salary of 1200 a year each. 
 
 3. That in future all promotions must take place among 
 those already in the Army, with due regard to seniority. 
 
 4. That the whole time of the Director-General and the 
 Principal Inspectors should be devoted to their duties. 
 District Surgeons were abolished, and the various grades 
 in the service were settled as follows Inspectors, 
 Deputy Inspectors, Physicians, Staff-Surgeons, Regi- 
 mental Surgeons, Assistant Surgeons, and Hospital 
 Mates, with respective salaries of 40s., 20s., 15s., 12s., 
 7s. 6d., and 6s. 6d. per diem. It was the duty of the 
 Director-General to examine hospital mates as to their 
 professional knowledge, but they were to possess the 
 
 1 For this correspondence, see "Parliamentary Papers," Vol. XIV, 
 1810, Army Medical Service.
 
 DURING THE REIGN OF GEORGE III 85 
 
 certificates of the Court of Examiners at the College of 
 Surgeons for regimental surgeons. Physicians were to 
 be chosen from Staff Surgeons, or were to be Licentiates 
 of the College of Physicians. The Director-General, 
 however, was empowered to hold in addition such ex- 
 amination as he thought proper. Finally, it was decided 
 that no member of the old Board should be eligible for 
 any of the seats on the new Board. l 
 
 On February 24th, 1810, these changes were carried 
 into effect, and Dr. John Weir was appointed the first 
 Director-General, with Theodore Gordon and Charles 
 Ker as the first Principal Inspectors. The old Board 
 with its impossible methods was swept away, and a new 
 era began in the Army Medical Service. Weir did not 
 hold his position for long, being succeeded in 1815 by 
 Sir James McGrigor, the glory of Army medicine, and 
 from his assumption of office may be dated the real 
 efficiency of the Service. 
 
 While the Committee was considering the Report 
 of the Commissioners for Military Enquiry, Sir Lucas 
 Pepys and Thomas Keate wrote several letters to the 
 Secretary at War, in which they complained that they 
 were not consulted with regard to the proposed changes. 
 Sir Lucas especially addressed communications to Lord 
 Palmerston, which must be pronounced to be ill-advised, 
 and in questionable taste. He began by doubting the 
 rumour that he would not be reappointed, and claimed 
 that as he had been appointed by the King it would 
 be an encroachment upon the royal prerogative to 
 supersede him. He spoke in terms of disparagement of 
 Dr. Weir, who was reported to be chosen to fill the 
 position of Director-General, and hinted that, being 
 between sixty and seventy years of age, he was too old 
 for the post. This was strange as coming from a man 
 
 1 The findings of the Committee, together with the correspondence of 
 Keate and Pepys will be found in " Parliamentary Papers," Vol. XIV, 
 1810, Army Medical Service.
 
 SQ MEDICINE IN ENGLAND 
 
 in his sixty-ninth year. Pepys also asserted that, to his 
 knowledge, he had never been remiss in the performance 
 of the duties of his office ; but how he reconciled this 
 statement with his refusal to proceed to Walcheren a 
 few months previously it is difficult to say. To all this 
 Palmerston replied in that laconic style so peculiar to 
 him. When Sir Lucas found that it had been definitely 
 decided that he should be superseded he was not given 
 the option of resigning he wrote humbly asking that 
 his case might be considered with reference to a pension. 
 This request was granted to him and his former col- 
 leagues, and the Army Medical Service embarked upon 
 its new career. 
 
 It has often been stated that the Army Medical Board 
 was deposed on account of its shortcomings with regard 
 to the Walcheren Expedition. This is a mistake, for the 
 Commissioners for Military Enquiry had printed their 
 Report before the Expedition was even thought of, and 
 it was on that Report alone that a change was decided 
 upon. The Walcheren Expedition was a coincidence 
 merely which still further confirmed the authorities in 
 their determination to effect a radical change. 
 
 But while salutary reform in the direction and control 
 of the Army Medical Department was making headway 
 an important advance had already taken place in the 
 knowledge of medical conditions as they existed in the 
 Army. Sir John Pringle may justly claim to be the 
 father of military medicine, for he gave the first impetus 
 to the study of this subject by the publication, in 1752, 
 of his book, " Diseases in the Army." The incessant 
 wars in which at that time this country became engaged 
 afforded great opportunities for the acquirement of 
 experience in this particular branch of medicine, and of 
 these Pringle availed himself to the fullest extent. The 
 appearance of Pringle' s book marks the first attempt to 
 systematise the subject, and to place it on a sure founda- 
 tion. The work is based on the experience of Pringle
 
 DURING THE REIGN OF GEORGE III 87 
 
 while engaged as Physician-General to Forces during 
 the campaigns of 1742-48 in Flanders, Germany, and 
 Scotland. This shrewd observer collected facts con- 
 cerning the incidence of disease in the Army, the effects 
 of climate and locality, and the influence of variations 
 of temperature and moisture on the health of the troops 
 while engaged on active service. 
 
 It is an appalling tale of serious disease constantly 
 following the footsteps of the Army, destroying its 
 efficiency, and producing havoc in its ranks, compared 
 with which losses in battle were trivial. The chief 
 diseases responsible for these losses in effectives were 
 dysenteries, remitting or bilious autumnal fevers, 
 hospital fever, or typhus, besides pneumonias, pleurisies, 
 and rheumatisms, which were of frequent occurrence. 
 Apparently hospital fever or typhus was present in 
 every hospital where soldiers were crowded together, 
 lying on straw which soon became rotten, and con- 
 stantly breathing the pestilential air, while in the open 
 camp this disease scarcely ever attacked them. For the 
 prevention of these diseases, Pringle advocated the 
 removal of the sick to small regimental hospitals, 
 rather than crowding them together in the large general 
 hospitals. He also laid much stress on the importance 
 of fresh air, dryness, and warmth, and on the necessity 
 for frequently changing the ground on which the camp 
 was pitched. 
 
 He studied with great care the climatic conditions, 
 and the endemic diseases of the countries passed through 
 by the troops. In particular he described at length 1 the 
 insalubrity of the island of Walcheren, and, sixty years 
 later, had the Government paid attention to his advice, 
 the disaster of 1809 would have been averted. For many 
 years Pringle' s book enjoyed a wide popularity ; it was 
 translated into many foreign languages, and several 
 editions were called for, the last being issued in 1810. In 
 
 1 See pp. 6-8, 58, and 171.
 
 88 MEDICINE IN ENGLAND 
 
 fact Pringle was the first to dignify disease in the Army 
 as a special subject, and he may be regarded as the 
 " doyen " of all the long line of eminent men who have 
 worked at this special branch of medical science. 
 
 Twelve years after the appearance of Pringle' s work, 
 Richard Brocklesby published his " Economical and 
 Medical Observations tending to the Improvement of 
 Military Hospitals," 1 a book scarcely less important, 
 but far less widely known, than its great forerunner from 
 the pen of Pringle. Brocklesby was a fearless writer, 
 and, as the lifelong friend and admirer of the great 
 Burke, it was only to be expected that his energies 
 would be directed towards the reform of abuses. This 
 was the aim of his book, and it is refreshing to read his 
 spirited attack upon the state of the Army hospitals 
 and the negligence displayed by those responsible for 
 the health of the troops. It required no little courage 
 for a physician to the Army to assail the imperfections 
 of the system and its exponents, but Brocklesby threw 
 caution to the winds and risked his position rather than 
 allow what he conceived to be abuses to pass without 
 comment. He had high ideals as to the duties of doctors 
 and commanders towards those over whom they were 
 placed in control, and he gave his opinions in no un- 
 certain manner. 
 
 Apart from the excellent style of the book the obser- 
 vations contained therein are often far in advance of 
 the times. Brocklesby was the first to point out and 
 carry into practice the principle that hospital fever or, 
 as we know it now, typhus, could only be checked by 
 admitting abundant fresh air into the hospitals. At 
 Sandy Heath, near Ripley, and at Winchester, he 
 caused to be constructed temporary hospitals cut out 
 of the chalk and sand in such a way that they admitted 
 a constant current of fresh air, with the result that the 
 
 1 The copy in the College library is of peculiar interest, for it contains 
 corrections for a new edition in the author's handwriting.
 
 fearful epidemic, which had hitherto raged in those 
 places, quickly subsided. His contempt for the plans 
 of existing hospitals at Hilsea and Chatham was un- 
 disguised. He also attacked the methods in vogue of 
 commandeering while on active service small cottages 
 to serve as hospitals, which were expected to accommo- 
 date forty sick men, although they were constructed 
 originally to house a family of five or six people. 
 
 Concerning the organisation of the Army Medical 
 Service he was no less outspoken. He held strongly the 
 view that, since most of the disease in the Army was 
 medical, physicians should have supreme control, and 
 that to them should be given the work of examining 
 candidates for the post of hospital mate. For the 
 surgeons he had no regard, and his strictures concerning 
 their want of education are certainly severe, although 
 he is careful to point out that he is attacking a class 
 and not individuals, some of whom he excepts by name. 
 He was of opinion that the surgeon of a regiment 
 should occupy a position immediately after the field 
 officers, and that both should work together for the 
 preservation of the health of the troops. In the matter 
 of medical knowledge, Brocklesby showed himself to 
 be a most widely read and accomplished physician, 
 and his views upon therapeutics are eminently practical 
 and free from the somewhat nauseous empiricism which 
 tinged the treatment of those days. He was the first 
 to advocate the view that the College of Physicians, 
 through the Censors, should examine those who wished 
 to enter the Army Medical Service, and this probably 
 influenced Pepys in the course he subsequently took. 
 
 Other physicians wrote concerning military medicine, 
 notably Donald Monro, 1 but none of them exercised 
 
 1 See " An Account of the Diseases of the British Military Hospitals 
 in Germany," 1764, and *' Observations on the Means of Preserving the 
 Health of Soldiers," 1780. An excellent and exhaustive review of works 
 on military medicine in this country, from the earliest times, will be found
 
 90 MEDICINE IN ENGLAND 
 
 such a profound influence upon the subject as Pringle 
 and Brocklesby. The work of these men was, no doubt, 
 responsible for much of the progress made in this field 
 of medicine, but it would have had little effect had it 
 not been for the unremitting endeavours to secure 
 departmental reform that came from within. The 
 names of McGrigor, Borland, Jackson, and Young are 
 closely associated with this movement, and it was 
 largely owing to their ceaseless activities that the Com- 
 missioners of Military Enquiry were induced to examine 
 the condition of the Army Medical Service in 1808. Their 
 epoch-making Report resulted in the first steps being 
 taken to place the service on a sound basis, and was the 
 beginning of better days for the Army doctor and the 
 soldier under his care. The advent of Sir James McGrigor 
 as Director-General of the Army Medical Service in 1815 
 marked the inception of a new era. This able man 
 infused into the service fresh ideas, and during the 
 long period he held offioe his sole aim was efficiency. 
 He decided that the enormous amount of clinical 
 material should not be wasted, and to this end he com- 
 pelled all surgeons to make careful reports of epidemics 
 and diseases coming under their notice. All this was 
 collected and arranged in some 350 folio volumes, a 
 worthy monument to his industry and ability. Por- 
 tions of these manuscripts were eventually published, 
 but much of it is not now available, for it has been 
 destroyed with other documents not thought important 
 enough for preservation. 
 
 The above account, then, is a brief outline of the 
 history of the development of the Army Medical Service 
 during the reign of George III. It has been shown that 
 at the beginning of the reign it hardly existed as_a 
 
 in a " A Concise View of the Progress of Military Medical Literature in 
 this Country," James Irving, M.D., Edinburgh. Stark and Co., 1846. 
 These reviews appeared in the " Edinburgh Medical and Surgical 
 Journal," No. 163.
 
 DURING THE REIGN OF GEORGE III 91 
 
 service, and was under no very efficient control. The 
 great work of Pringle and Brocklesby, who did so much 
 to make military medicine a distinctive branch, has 
 been described, and the causes which were responsible 
 for the Report of the Commissioners for Military En- 
 quiry in 1808 have been traced. After effect had been 
 given to the findings of the Commissioners came Sir 
 James McGrigor, the prince of all Directors-General, 
 and from the time he assumed control may be dated the 
 modern Army Medical Service. Although the Army 
 Medical Service has passed through many vicissitudes 
 since then, the main principles of control initiated by 
 McGrigor have not undergone any fundamental change. 
 
 THE WALCHEREX EXPEDITION 
 
 In the description just given of the development of 
 the Army Medical Service allusion has been made to 
 the Walcheren Expedition, and since, from a medical 
 point of view, it was a most important military under- 
 taking, it becomes necessary to devote space to its con- 
 sideration. The disasters which befell this venture 
 were so intimately connected with medical science that 
 it is almost impossible for the historian unacquainted 
 with medicine to write an adequate account of the ex- 
 pedition. In a few short weeks disease swept off, or 
 rendered incapable of military service, a fine army of 
 40,000 men. Medical reputations were made and 
 blasted, and the evils of divided and incompetent 
 medical control were made abundantly clear. The 
 annals of the British Army contain many instances of 
 the terrible havoc caused by epidemic disease, but it 
 may be doubted if a more appalling tale of disaster pro- 
 duced by sickness and protracted by the supineness of 
 the high medical authorities has ever been recorded. 
 Sickness amongst the troops and inability to cope with 
 it occupied a very considerable part of the despatches 
 of the Commanders-in-Chief, and the tone running
 
 92 MEDICINE IN ENGLAND 
 
 through them all was one of failure, hopelessness, and 
 panic. 
 
 The medical history of the expedition may be said to 
 have begun with the capture of Flushing on August 15th, 
 1809, for at about that time sickness in an unusual 
 degree began to be recorded among the troops quartered 
 in South Beveland. The disease rapidly assumed 
 alarming proportions, and by September 10th, when 
 Lord Chatham returned with part of the Army, leaving 
 16,000 men to hold the island of Walcheren, 8000 of 
 these were on the sick list. The diagnosis of the com- 
 plaint presented no difficulty ; it was clearly miasmatic 
 in origin, and such as might be expected from a resi- 
 dence in the swampy islands of Beveland and Walcheren 
 during the summer and autumn. Indeed, these islands 
 had for a long time borne an evil reputation as being 
 the most fever-ridden places in Europe. There was 
 ample evidence of this, for, sixty years before, Sir John 
 Pringle had given a full description of the complaint as 
 it occurred in these same islands. 
 
 Much has been written concerning the conditions 
 existing in Walcheren, but the most complete picture 
 of the state of the Army, and the climate, will be found 
 in a letter written on September llth by Mr. John Webbe, 
 the Inspector of Hospitals. He says : " Independent 
 of the existing records of the unhealthiness of Zealand, 
 every object around us depicts it in the most forcible 
 manner. The bottom of every canal that has direct 
 communication with the sea is thickly covered with an 
 ooze which, when the tide is out, emits a most offen- 
 sive effluvia. Every ditch is filled with water which 
 is loaded with animal and vegetable substances in a 
 state of putrefaction, and the whole island is so flat and 
 near the sea that a large proportion of it is little better 
 than a swamp, and there is scarcely a place where water 
 of a tolerably good quality can be procured. The effect 
 of all these causes of disease is strongly marked in the
 
 DURING THE REIGN OF GEORGE III 93 
 
 inhabitants, the greater part of whom are pale and 
 listless. The endemic disease of this country, re- 
 mittent and intermittent fevers, begins to appear about 
 the middle of August and continues to prevail until the 
 frosty weather checks the exhalation from the earth, 
 gives tone to the debilitated frames of the people, and 
 stops thereby the further progress of the complaints. 
 It is computed that nearly a third of the inhabitants 
 is attacked with fever every sickly season. . . . The 
 fever which now unhappily prevails in the Army first 
 appeared among the battalions cantoned in South 
 Beveland, and only began to demonstrate its influence 
 here about the time that Flushing surrendered. The 
 rapidity with which the disease has extended itself 
 during the short period that has elapsed is almost un- 
 exampled in the history of any military operations. . . . 
 A considerable number of cases have assumed a more 
 serious form, and have degenerated into that species 
 of low fever which often prevails in jails and other ill- 
 ventilated places in England. As the progress of the 
 mischief is much greater than could rationally have 
 been calculated upon, ... it must be an inevitable 
 consequence of the British troops remaining in Wal- 
 cheren that a very considerable loss must be sustained." 1 
 Such was the state of the Army in Walcheren on 
 September llth, and time was to show that Webbe's 
 gloomy forebodings were amply justified. Three days 
 after writing his letter he was stricken down with the 
 fever, and the duty of supreme direction fell upon 
 Francis Burrows, the next in seniority after death had 
 removed Mr. Aveling. The necessity for more doctors 
 became urgent, and on September 14th one staff surgeon 
 and three hospital mates arrived, with the excuse from 
 
 1 For this letter, and the facts upon which this account of the Wal- 
 cheren Expedition is based, see " Papers Presented to Parliament Con- 
 cerning the Expedition to Walcheren," 1810, and " The 'Evidence taken 
 before the House of Commons regarding Walcheren," in Hansard, Vols. 
 XV and XVI.
 
 94 MEDICINE IN ENGLAND 
 
 the Army Medical Board that the war in the peninsula 
 had made such excessive demands upon the supply of 
 surgeons as to render it impossible to send more. The 
 condition of the Army was now deplorable, and the 
 despatches of the Commander, Sir Eyre Coote, dealt 
 with little else than the ever-increasing sickness. Out 
 of an army of sixteen thousand men no less than half 
 were in hospital. The accommodation for the sick was 
 of the worst description, and houses and churches in 
 Flushing, the roofs of which had been destroyed by 
 the bombardment, did duty as hospitals. There were 
 no convalescent hospitals ; the supply of blankets, 
 wines, and medicines began to fail, and on September 
 23rd, Sir Eyre Coote reported that only three hundred 
 pounds of bark remained in store. Typhus fever now 
 made its appearance, and it became evident that strong 
 measures were necessary to cope with this dangerous 
 condition. 
 
 The Government at last became alarmed, and in 
 response to the urgent solicitations of Sir Eyre Coote, 
 they requested Sir Lucas Pepys, the Physician-General, 
 and Mr. Keate, the Surgeon-General, to proceed to 
 Walcheren to deal with the terrible sickness which 
 existed in that island. But, to the astonishment of all, 
 Sir Lucas begged to be excused on the ground that he, 
 the Physician-General to the Army, " knew nothing 
 about the investigation of camp and contagious dis- 
 ease " ! Keate also refused for the reason that " he 
 conceived he would be of greater use at home." In this 
 dilemma the Government appointed a medical com- 
 mission, composed of Sir Gilbert Blane, with the title 
 of Acting Physician-General, Dr. James Borland, and 
 Dr. William Lempriere, who were instructed to proceed 
 to Walcheren and report upon the malady prevalent 
 there. In addition they appointed Dr. James McGrigor 
 Inspector-General of Hospitals. Blane and McGrigor 
 arrived on September 30th, and at once made a close
 
 DURING THE REIGN OF GEORGE III 95 
 
 examination of the conditions as they existed. They 
 found the roofless churches, houses, and other buildings 
 crowded with sick men, and every day bringing 
 fresh cases in hundreds. They found the medical staff 
 quite insufficient to cope with the work, and the stock 
 of medicines and medical comforts almost exhausted, 
 while, pervading all, they found an atmosphere of 
 paralysis, panic, and despair. 
 
 The minds of Blane and McGrigor were soon made up 
 as to the course to be pursued, and on October 1st they 
 addressed a joint letter to Sir Eyre Coote, embodying 
 the measures they judged suitable for the amelioration 
 of this distressing state of affairs. As a first precaution 
 they recommended that about six thousand sick men 
 should be shipped to England in ships of the line, 
 since transports were inadequate. Sir Eyre Coote 
 accepted this suggestion, and during the month of 
 October the evacuation of the hospitals proceeded, 
 with the result that for the first time the depleted 
 medical staff was in a position to cope with the daily 
 influx of sick soldiers. 
 
 Blane and his two colleagues returned home on 
 October 10th, but McGrigor remained in supreme 
 charge of all the medical arrangements. Here, he 
 laid the foundation of his immense reputation, and by 
 his energy and sagacity quickly changed the state of 
 medical chaos into one of tolerable efficiency. Sir 
 Eyre Coote gave up the command of the Army on 
 October 29th, and was succeeded by General Don, the 
 third commander to occupy this unenviable position in 
 four months. It w r as a sorry Army he \vas called upon 
 to command, for he reported that he had only 4534 
 men fit for duty, of which about one-third was unfit for 
 considerable exertion. But the agony of Walcheren 
 was soon to be terminated, for the Government decided 
 to evacuate the island. On December 9th the poor 
 remains of the Army embarked ; on December 23rd
 
 96 MEDICINE IN ENGLAND 
 
 all the heavy ordnance followed, and thus ended the 
 famous expedition. 
 
 An exhaustive enquiry took place in 1810, by a 
 Committee of the House of Commons, and the examina- 
 tion of the medical men connected with the expedition 
 revealed an extraordinary state of divided control. 
 The evidence of the members of the Army Medical 
 Board and other doctors showed that the authorities 
 had never consulted the Board with reference to the 
 condition in Walcheren until the sickness began to be 
 excessive. Indeed, until the expedition arrived in the 
 Scheldt, the Board was ignorant of its destination and, 
 therefore, no special provision was made to counteract 
 the dangers of the climate. Although it was proved 
 that the medicines ran dangerously short, there was no 
 evidence to show that the troops were ever in actual 
 want. Blankets and other medical comforts were 
 certainly in insufficient supply, and there was a totally 
 inadequate medical staff to deal with the enormous 
 amount of sickness, although some half-hearted at- 
 tempts appear to have been made to remedy this 
 defect. In fact the chief blame that could be attached 
 to the Board was that, when the amount of sickness 
 became known, it exhibited a supineness in grappling 
 with the difficulty which nothing could excuse. No 
 measures taken before the expedition started would 
 have had any great effect upon the sickness, for the 
 disease was malaria, which was endemic in Walcheren 
 at the time the Army landed. With the exception of 
 some cases of typhus it was the sole cause responsible 
 for the sickness, and removal from the evil climatic 
 influences was the only remedy. 
 
 Many writers when dealing with the medical mission 
 of Sir Gilbert Blane to Walcheren have assigned to 
 him alone the credit, and have claimed for him a posi- 
 tion that appears to be not altogether supported by an 
 examination of the facts. They have made it appear
 
 DURING THE REIGN OF GEORGE III 97 
 
 that Blane alone was sent out to Walcheren, that he 
 alone made a report to the Government which led to 
 the island being abandoned, and that he alone was 
 thanked for his services. What really happened was 
 as follows : In letters dated September 24th and 26th, l 
 the Commander-in-Chief requested Sir Lucas Pepys, 
 with two other physicians of eminence, to proceed to 
 Walcheren " to examine further into the malady 
 prevalent in that island, and to report their opinion 
 thereupon." As has already been stated, Sir Lucas 
 begged to be excused, and Blane was appointed head 
 of the Commission, with the title of Acting Physician- 
 General. The other two members of the Commission 
 were Dr. James Borland and Dr. William Lempriere. 
 Blane reached Walcheren on September 30th, but 
 Borland and Lempriere did not arrive until October 5th. 
 Then a strange thing happened. Blane did not wait 
 for the arrival of his colleagues, nor did he consult with 
 them for some days after, but on October 3rd, 6th, and 
 9th, he sent letters to Sir Lucas, in which he dealt with 
 the sickness on the island on his own responsibility. 2 
 Sir Lucas transmitted these letters to the Secretary at 
 War, who regarded this proceeding on the part of Blane 
 as improper, for he ordered Sir Lucas Pepys to be 
 " apprised that Dr. Blane's reports are not to supersede 
 the report that he, in conjunction with Drs. Borland 
 and Lempriere, has been instructed to make concerning 
 the malady prevalent on the island." 3 It is possible 
 that these letters were sent by Blane to Sir Lucas at 
 the latter' s suggestion, for after the surprise occasioned 
 by his refusal to proceed to Walcheren, he would 
 naturally desire to be the medium of transmitting first 
 
 1 See " Papers Presented to Parliament Concerning the Expedition to 
 Waloheren," 1810. Letters 67 and 67 E. 
 
 * See Letters 97, 103, and 110E, in ' Papers Presented to Parliament 
 Concerning Walcheren," 1810. 
 
 1 See Letter 97 E.
 
 98 MEDICINE IN ENGLAND 
 
 hand to the Secretary at War any information regarding 
 the sickness. But while these somewhat subterranean 
 methods were being practised by Blane, the Commission 
 was making its official report. This report was signed 
 on October 10th by the three members of the Com- 
 mission, 1 and on October 17th the Commander-in-Chief 
 dissolved the Commission, transmitting at the same 
 time the thanks of the Secretary at War for their 
 services. 2 Sir Lucas Pepys evidently sent to Blane the 
 letter of the Secretary at War, in which he refused to 
 allow the letters to supersede the Official Report, for 
 on October 10th Blane wrote to Pepys, 3 and excused 
 himself for going behind the backs of his colleagues on 
 the grounds of their late arrival, and the pressing nature 
 of the business. These excuses appear to be somewhat 
 insufficient, nor was it a graceful act on the part of 
 Blane to call special attention to the assistance he had 
 received from Dr. Lempriere, while omitting alto- 
 gether the name of Borland. But Borland was not 
 liked by the Army Medical Board, for -he was a re- 
 former, and that is perhaps the reason for the omission 
 of his name. 
 
 The above is the history of the medical communica- 
 tions made by Blane and the other members of the 
 Commission. In them all there is not a single sugges- 
 tion that the island should be evacuated. On the 
 contrary, in Section 3 of the Official Report a method 
 is advocated for further garrisoning the island with 
 freedom from sickness. It says : " We presume to 
 recommend to His Majesty's Government, in case the 
 retention of the island should be determined on, to 
 reinforce the garrison very early in the winter." 
 Indeed, from a perusal of the papers relative to the 
 expedition and presented to Parliament in 1810, 4 it 
 is evident that the reason for the abandonment of the 
 
 1 See Letter 104 E. a See Letter 109 E. See Letter 110 E. 
 4 See Hansard, Vol. XV, 1810.
 
 DURING THE REIGN OF GEORGE III 99 
 
 island was entirely political. This is set out clearly in 
 a despatch from Lord Liverpool to General Don on 
 October 27th, 1809. In that despatch it will be seen 
 that the retention of the island of Walcheren was held 
 to be useless after the peace between Austria and France 
 had been signed on October 14th. While the negotia- 
 tions begun between Austria and France after the 
 armistice of Zynam dragged on, the occupation of 
 Walcheren was clearly a help to Austria, but already 
 the situation of the British troops was precarious. 
 Bernadotte had arrived in Antwerp with a considerable 
 army, and with Napoleon's forces set free by the 
 signing of the peace it became madness to think of 
 holding the island against such overwhelming strength. 
 It was, therefore, of necessity given up. 
 
 It would appear, then, that the account generally 
 given of Blane's position with regard to the Walcheren 
 Expedition is not quite correct. Too much importance 
 has been attached to the part he played, and the names 
 of his colleagues have been, unwittingly, no doubt, 
 suppressed. That his services were most meritorious 
 cannot be denied, and when Sir Lucas Pepys failed to 
 rise to the occasion, it is doubtful if a more competent 
 man could have been found to lead a Commission 
 engaged upon such a vital medical matter. 1 
 
 1 Blane received ,1.500 for his visit to Walcheren, but Sir Lucas Pepys 
 was not consulted concerning this grant. The matter was referred to 
 Sir Henry Halford, who suggested the above sum. See " Life of Sir 
 Henry Halford," by Munk, p. 49.
 
 CHAPTER IV 
 
 THE NAVAL MEDICAL SERVICE FAMOUS SICK-BEDS 
 
 IN order to complete the consideration of Medicine in 
 relation to the State during the reign of George III, the 
 conditions existing in the Naval Medical Service have 
 still to be described. 
 
 Materials for the study of the early history of medicine 
 in the Navy are extremely scanty, and it is not possible 
 to describe with any degree of exactness the phases 
 through which it passed until it became an established 
 branch of the Service. Records from comparatively 
 early times do, however, exist which show that physicians 
 and surgeons were appointed from time to time to attend 
 the commanders of various naval expeditions, and pre- 
 sumably to advise them concerning medical questions. 
 One of the first of these appointments, if not actually 
 the first, was that of Roger Marbeck, a Fellow, and the 
 first Registrar of the College of Physicians, who was 
 appointed to attend on the Lord High Admiral Howard 
 in his expedition to Cadiz in 1596. In the British 
 Museum will be found a manuscript of Marbeck, in 
 which he gives an account of his adventures, and this 
 may be regarded as the first report in existence dealing 
 with the medical service of the Navy. 1 In the following 
 year (1597) Henry Atkins, a President of the College of 
 Physicians, was appointed to the expedition of the Earl 
 of Essex to Spain. The agonies of sea-sickness, however, 
 only permitted him to go as far as Plymouth, where he 
 
 1 B.M., Add. MSS. "A briefe and True discourse of the late Honour- 
 able Voyage in to Spaine," by Dr. Marbeck. 
 
 100
 
 DURING THE REIGN OF GEORGE III 101 
 
 was landed in an exhausted condition, and his place was 
 taken by Thomas Moundford, another President of the 
 College of Physicians. 1 
 
 In Cromwellian times it became the practice to 
 appoint physicians to naval expeditions proceeding to 
 foreign waters, and the duties attached to these appoint- 
 ments referred more to the care of the sick on board 
 than to the care of the health of the commander of the 
 expedition. Thus, Paul de Laune was appointed by 
 Cromwell as physician to the Fleet proceeding to 
 Jamaica under Penn and Venables. Soon after this 
 the practice became established, and physicians and 
 surgeons were regularly appointed to most of the 
 warships in commission. 2 
 
 Early in the eighteenth century medical affairs in 
 the Navy were under the control of the " Sick and Hurt 
 Board," which was composed of medical and lay 
 members. From an inspection of the minutes of this 
 Board in the Public Record Office it does not appear 
 that the authority conferred upon it was very ample, 
 and for the most part its functions were advisory, but 
 even then, only when applied to by other Naval depart- 
 ments. 3 Indeed, at this time little care was taken of 
 the health of seamen on whom depended the safety 
 of these islands, and such solicitude as existed for their 
 medical welfare was dependent almost entirely upon 
 the energy and conscientiousness of individual naval 
 surgeons. The standard of medical education required 
 was of the lowest kind ; they were obliged to provide 
 their own drugs and instruments, and the authorities 
 made no attempt to raise the medical service. But the 
 work of the two great pioneers, James Lind and Gilbert 
 
 1 See "Munk's Roll" for the accounts of Marbeck, Atkins, and 
 Moundford. 
 
 1 See " Munk's Roll " for the account of Paul de Laune. 
 
 * See ''Minutes of the Sick and Hurt Board," Admiralty Series, 
 Public Record Office.
 
 102 MEDICINE IN ENGLAND 
 
 Blane, produced a complete reformation in the Naval 
 Medical Service, and it is not too much to say that the 
 whole of the improvement in Naval Medicine which 
 took place during the reign must be attributed to the 
 work of these great men. On account of the great in- 
 fluence they exercised over medical progress in the 
 Navy it will be necessary to examine their writings. 
 
 To Lind perhaps belongs the greater honour, for his 
 was the first definite attempt to improve the position of 
 medicine and hygiene in the Navy. In 1754 he published 
 his work on scurvy, a disease with which he was fully 
 acquainted from the practical point of view. Previous 
 to him, many writers had, it is tine, dealt with the 
 subject, but in most of the accounts given no clear and 
 precise description of the clinical features of the com- 
 plaint can be found. Lind sketched with really masterly 
 hand the special features of this disease, and so ably did 
 he delineate the picture that his description has been 
 followed ever since. But he did more, he indicated for 
 the first time the principles of treatment of scurvy, 
 and showed that, provided the proper ant i -scorbutics 
 were carried on board ship, its terrible ravages would 
 very soon become unknown. His wise advice, however, 
 fell upon unheeding ears, and many years were to elapse 
 before scurvy on board ship ceased to limit the naval 
 and mercantile activities of this country. 
 
 In 1757 Lind published " An Essay on the most 
 Effectual Means of Preserving the Health of Seamen." 
 The book is not remarkable for its literary style, but is, 
 nevertheless, full of shrewd observations and practical 
 suggestions founded on an extensive acquaintance with 
 disease on board ship. It is one of the most practical 
 books ever written, and it is astonishing how true, 
 even to-day, are many of the observations it contains. 
 His recommendations concerning the care of the health 
 of seamen, his insistence on the necessity for taking 
 bark as a precautionary measure against miasmatic
 
 DURING THE REIGN OF GEORGE III 103 
 
 fevers, his remarks regarding hospitals on board ship, 
 and the prevention of infection, had they been attended 
 to, would have saved the lives of thousands of sailors. 
 Probably, however, he was aware of the amount of 
 prejudice his innovations would encounter, and this is 
 the reason why his wise counsels are couched in a 
 somewhat df^erential tone. 
 
 Lind was essentially a pioneer in naval medicine and 
 hygiene. In an age when no thought was given to 
 the care of seamen on board fighting ships, when harsh 
 and repressive discipline was common, he had the 
 courage to point out to the authorities the importance 
 of conserving the health of those on whom the country 
 depended for its defence. His work was epoch making, 
 and from the time that he wrote the attention of the 
 Navy Board was tardily drawn to this important 
 subject. The impetus thus given gained force in suc- 
 ceeding years, until a better state of health in the Service 
 was reached. 
 
 If it be true that Lind sowed the seed of medical and 
 hygienic reform in the Navy, it is equally true that 
 Blane tended and garnered the grain, and it is doubtful 
 whether the principles introduced by Lind could have 
 obtained such wide acceptance without his powerful 
 support. Blane was eminently fitted for such work ; 
 he was possessed of a most logical mind, a determined 
 yet cautious spirit, and the ardour of a true reformer. 
 He brought these qualities to bear on his work, and when 
 he resigned the chief medical direction of the Navy in 
 1802 a brighter era of medical progress and efficiency 
 had already dawned. 
 
 In 1785 Blane published his book, " Observations on 
 the Diseases of Seamen," and it quickly ran through 
 many editions. The plan of the work bears a somewhat 
 close similarity to that of Lind. Its literary style is 
 easy, almost graceful, and the method, true to the 
 nationality of the author, is mainly deductive. But
 
 104 MEDICINE IN ENGLAND 
 
 the chief excellence of the work is its foundation on a 
 wide clinical experience. Blane had little sympathy 
 with mere theory, and in his preface he writes : " The 
 theoretical doctrines of physic have generally no better 
 foundation than hypothesis, and have taken their colour 
 from the prevailing philosophy of the times." The book 
 is divided up into three sections. The first gives a 
 detailed account of the sickness in the Fleet under the 
 command of Lord Rodney while cruising in the West 
 Indies from 1781 to 1783, and to which Fleet Blane was 
 appointed as physician in charge. He ordered the 
 surgeons of ships to take complete notes of the cases, 
 and to furnish exact returns. These results he com- 
 piled, and for the first time almost made use of the 
 statistical method in a manner simple yet correct. Al- 
 though Blane' s statistics would by no means satisfy 
 an actuary, still his logical mind kept him clear of 
 those pitfalls in figures and their manipulation into 
 which our profession is so prone to stumble. The net 
 result of his tables was that the annual mortality in 
 the Fleet from disease amounted to 125 per 1000 ; 
 not an excessive mortality when judged by the standards 
 of those times. 
 
 The second section of the book deals with the causes 
 and prevention of disease, and here Blane frankly 
 admits that much of the subject matter is derived from 
 Lind. Indeed, in this section, it is Blane the disciple 
 who is advocating the principles of the master. In the 
 third division of the work observations on fevers are 
 given, and, from the point of view of clinical acumen, 
 this part is the most able and original of all. 1 
 
 The work of Blane and Lind had a profound effect 
 upon the Naval Medical Service, and it stimulated 
 surgeons to devote their attention to the medical needs 
 
 1 For further information concerning the career of Blane see an ex- 
 .cellent memoir by Sir Humphry Rolleston, published in the Journal of 
 the Royal Naval Medical Service in 1816.
 
 DURING THE REIGN OF GEORGE III 105 
 
 of those placed under their care. But Blane and Lind 
 were not the only pioneers in this field. The labours of 
 Thomas Trotter, 1 in the direction of a more efficient 
 medical service in the Navy, and towards improvement 
 in the Naval Hospitals, although scarcely less important 
 than those of Blane, were marred by a disposition to 
 attack the ruling powers for their failure to promote 
 reforms. Robert Robertson, a Licentiate of the College 
 of Physicians, was another reformer who did much to 
 quicken the sense of the Navy Board towards the im- 
 perfection of the Naval Medical Service. a 
 
 Not only were surgeons stimulated to fresh activity 
 by the work of these men, but the Naval authorities 
 began to show interest in the subject of the preservation 
 of the health of seamen, and in 1795 a step was taken 
 by the Navy Board which had far-reaching effects. 
 In that year Lord Spencer, the First Lord of the Ad- 
 miralty, reconstructed the old Sick and Hurt Board, 
 and, under the name of the Commissioners for Sick and 
 Wounded, set up an authority composed of two phy- 
 sicians and one civil member. To these he delegated 
 the direction of all medical matters in the Navy, and 
 for the first time medical men were responsible for the 
 Naval Medical Service. Dr. Robert Blair and Dr. 
 Gilbert Blane were the two medical Commissioners, 
 and Sir William Gibbons was the civil representative. 
 Blair, however, soon retired, and was succeeded by 
 Blane, who at once began to put into practice the 
 principles he had advocated years before. In all, he 
 remained seven years in supreme control of the medical 
 service in the Navy, and when, in 1802, he retired, 
 the Naval Medical Service had been thoroughly re- 
 generated, abuses had been modified or removed, 
 
 1 See " Medicina Nautica," Thomas Trotter, 1797. 
 
 2 See "A Physical Journal kept on board the "Rainbow," 1779, 
 "Observations on Jail, Hospital, or Ship Fever," 1779. "An Essay on 
 Fevers," 1790.
 
 106 MEDICINE IN ENGLAND 
 
 i 
 
 and the way was left clear for progress on prudent 
 
 lines. 
 
 Blane was succeeded by John Harness, who had been 
 appointed a Commissioner in 1800, and he, with organ- 
 ising ability superior even to that of his predecessor, 
 carried forward still further the work of reform. At 
 this time it was felt that the work of the medical de- 
 partment of the Navy was onerous enough to demand 
 the undivided attention of the Commissioners, and it 
 was therefore decreed that they should not engage in 
 private practice. It was soon, however, found that the 
 Commissioners for Sick and Wounded were not suffi- 
 ciently in touch with the other departments in the 
 Admiralty, and in 1806 the Board was abolished. The 
 functions of the Board were now performed by the 
 Senior Medical Commissioner who sat at the Transport 
 Board, and thus the control of medical matters was 
 vested in one head. Inspectors of Naval Hospitals were 
 appointed in 1804, who acted under the direction of the 
 Medical Commissioner, and in 1817 the Medical Com- 
 missioner was again transferred, this time to the Victu- 
 alling Board, but his functions were the same. Besides 
 Harness, John Weir and Andrew Baird shared in the 
 work, and at the end of the reign of George III, the 
 principles of medical control in the Navy under one 
 authority were well established and have served as the 
 model for all subsequent changes. 1 
 
 The review of medical effort during the reign is now 
 completed, and it is proposed to devote the remaining 
 pages to an account of the scenes taking place around 
 some famous sick-beds when George III was king. 
 It has been urged that a consideration of the illnesses 
 and deaths of eminent personages does nothing to 
 
 1 For most of the facts concerning the development of the Naval 
 Medical Service, use has been made of the evidence of John Harness 
 before the Commissioners of Military Enquiry in 1808, which deals fully 
 with the history of the movement.
 
 DURING THE REIGN OF GEORGE III 107 
 
 advance the knowledge of medicine ; that it feeds only 
 a morbid curiosity which good taste often demands 
 should be left unsatisfied. While admitting, however, 
 some show of justice in this criticism, especially when 
 applied to the uninstructed, it may be asserted that 
 the subject of the history of medicine should embrace 
 this special feature, and that a useful purpose will be 
 served by its study. Biographers, however able in a 
 literary sense, have rarely possessed the expert know- 
 ledge necessary for a truthful account of the illnesses 
 and deaths of their heroes. On account of this defici- 
 ency they have often committed ludicrous errors, and 
 have built up a medical nomenclature and pathology 
 peculiarly their own, of which " brain fever," the beauty, 
 and even pleasure, of death from consumption, and 
 the estimation of a man's large-heartedness from the 
 amount of cardiac hypertrophy found, are some ex- 
 amples. 
 
 There are good reasons for an investigation of this 
 kind by those skilled in medicine. In periods of ill- 
 health a man, however great, cannot exercise to the 
 full his mental powers, and it becomes the province of 
 the physician to determine how far bodily and mental 
 ailments have influenced judgment and action. Crises 
 in history and unaccountable lapses of great figures in 
 the world may often be explained by an enquiry into 
 the state of health. Then, the last spoken words of 
 people when " in extremis " have always exercised a 
 fascination over the minds of those who read bio- 
 graphy ; but the physician knows the amount of value 
 to be attached to such utterances at a time when the 
 higher processes of the brain have often ceased to be in 
 active operation. 
 
 After this justification, therefore, it is proposed to 
 describe the illnesses of a few of the more distinguished 
 patients who were attended by physicians in the reign 
 of George III. The first case calling for special considera-
 
 108 MEDICINE IN ENGLAND 
 
 tion is that of the monarch who ruled over England 
 during the whole of the period covered by these lectures. 
 The family history of George III was by no means 
 good. On his mother's side, who was of the Gotha 
 family, feeble-mindedness, if not actual insanity, had 
 manifested itself. As for his father, Frederic Prince of 
 Wales, all the memoirs and histories of the period in 
 which he lived have failed to disclose one single redeem- 
 ing feature in his character. He was a degenerate 
 beyond recall. From the first, the intellect of George 
 was essentially dull, and the education provided for 
 him was calculated to accentuate, rather than improve, 
 his mental obtuseness and natural mulish obstinacy. 
 He, therefore, grew up with restricted views and many 
 eccentricities, which a proper education might have 
 softened, although it never could have removed. No 
 king of England was ever on the throne during such 
 mighty intellectual changes. Against every improve- 
 ment he fought with all his dogged persistence, and 
 although one cherished relic of obsolete feudalism after 
 another was swept away he still failed to profit by the 
 experience. 
 
 It has been stated, though on no very sure authority, 
 that George III showed signs of mental derangement 
 as early as 1765. But however that may be, at a levee 
 on October 24th, 1788, it was noticed that the King was 
 strange in his manner and speech. A few days after, 
 undoubted symptoms of insanity appeared which, with 
 varying periods of remission, endured for the remainder 
 of his life. The King's physicians, Dr. Richard Warren, 
 Sir George Baker, Sir Lucas Pepys, and Dr. Revell 
 Reynolds were early in attendance, and on November 
 26th, at the express command of the Prince of Wales, 
 Dr. Addington was recalled from his retirement to assist 
 his colleagues. He remained in consultation, however, 
 for four days only. 
 
 The symptoms of the malady presented no unusual
 
 DURING THE REIGN OF GEORGE III 109 
 
 feature. It was a case of delusional insanity attended 
 with exacerbations of mania followed by periods of 
 melancholia. But insanity in the King raised political 
 considerations of the utmost importance. No prece- 
 dents existed to guide the two estates of the realm, and 
 until arrangements could be made the whole fabric of 
 government was in abeyance. It was necessary, there- 
 fore, to ascertain if the King was really incapable of 
 exercising his regal functions, and further to know how 
 long it would be before recovery took place. Thus it 
 will be seen that the physicians were charged with a 
 serious responsibility, for upon them rested the duty 
 of answering these important questions. 
 
 Nor was this all. The state of the two great political 
 parties still further complicated matters and rendered 
 the position of the physicians onerous in the extreme. 
 Both the Whigs and the Tories were agreed that the 
 only way out of the difficulty was to appoint the Prince 
 of Wales as Regent during the incapacity of the King. 
 But the Whigs, headed by Fox, Burke, and Sheridan, 
 regarded the Prince of Wales as their leader, and 
 naturally desired for him a Regency of indefinite dura- 
 tion and ample powers. They were chiefly concerned 
 to make their position secure in the future and not 
 merely for a short period. It was their aim, therefore, 
 to prove out of the mouths of the physicians that it 
 was probable that the King's illness would be of long 
 duration. On the other hand, the Tories, headed by 
 Pitt, knowing that their tenure of power would be 
 ended on the assumption of the regal functions by the 
 Prince of Wales, were equally anxious to limit the 
 Regency both with regard to its powers and duration. 
 They also, like the Whigs, sought to find in the answers 
 of the physicians arguments to support their views. 
 Therefore, however much the physicians might desire 
 to remain aloof from the political turmoil, they were 
 soon to find that they were sucked into the vortex,
 
 110 MEDICINE IN ENGLAND 
 
 and were made to take sides often against their inclina- 
 tion's. 
 
 In order to ascertain the views of the physicians, 
 they were called and examined before the Privy Council 
 on December 3rd, and the evidence they gave was laid 
 before both Houses of Parliament. Each House then 
 appointed a Committee to examine the physicians at 
 length, and on December 10th and llth they underwent 
 their examination before these Committees. In the 
 interval two other physicians had been called in ; Dr. 
 Francis Willis on the advice of Lord Chancellor Thurlow, 
 and Dr. Thomas Gisborne at the request of the regular 
 physicians in attendance upon the King. The advent 
 of Dr. Willis through the instrumentality of Thurlow 
 savoured somewhat of a political manoeuvre, for the 
 Lord Chancellor was a past master in intrigue, and, as 
 will be seen, the answers given by Willis were uniformly 
 on the side of the King's party, of which Thurlow was 
 at that time a pillar. The arrival of Willis on the scene 
 was also viewed with disfavour by the other physicians, 
 for he could scarcely be regarded as a regular practi- 
 tioner. He was, it is true, a Doctor of Medicine of Oxford, 
 but this had been conferred more to regularise his posi- 
 tion as a proprietor of a madhouse than as proof that 
 he had made a serious study of medicine. He was also 
 a Doctor of Divinity, and for a time had been vicar of 
 St. John's, Wapping. For the rest he was a man of most 
 commanding presence, tall and handsome, and had 
 acquired considerable renown on account of his successful 
 treatment of the insane at his madhouse at Gretford, 
 in Lincolnshire. As events were to show, he possessed 
 more experience of lunacy than any of the other phy- 
 sicians, and, throughout, his opinions were more definite, 
 and, therefore, carried greater conviction. 1 
 
 1 For the few particulars concerning Francis Willis see " The Gentle- 
 man's Magazine," 1807, and "Life of George III," Jesse, Vol III. He 
 was educated at Brazenose, graduated M.A., in 1740, and M.D. in 1759. 
 He died in 1807 in his ninetieth year.
 
 DURING THE REIGN OF GEORGE III 111 
 
 The conclusions arrived at as the result of the 
 examination of the physicians may be summarised as 
 follows : 
 
 1. They all agreed that the King was incapable of 
 transacting business. 
 
 2. They all expressed hopes of his recovery, especi- 
 ally Addington and Willis, but they would not venture 
 a definite opinion as to when the recovery might be 
 expected. Willis, however, gave the duration as from 
 six weeks to two years. 
 
 3. All were questioned as to their experience of mental 
 disease. Pepys and Gisborne confessed to having had 
 little experience. Addington and Willis owned to con- 
 siderable experience, while Warren, Baker, and Reynolds 
 appealed to such cases as had arisen in their extensive 
 practices spread over many years. 
 
 4. None of the physicians could see any signs of con- 
 valescence, and none would assign a cause for the 
 attack, except Willis, who thought that too much 
 business, severe exercise, too little sleep, and much 
 abstemiousness were chiefly responsible. 1 
 
 Although these conclusions exhibited much caution 
 on the part of the physicians, evidence was not wanting 
 that already the King's party was looking to Willis as 
 their chief medical support, while the Whigs had fixed 
 upon Dr. Warren as the physician most likely to further 
 their aims. No improvement took place in the King's 
 health, and on January 6th, 1789, Burke pressed for a 
 Committee to enquire concerning it. He stated that, 
 contrary to expectation, the King's health had not im- 
 proved, and he read Dr. Warren's evidence, given in 
 December, to support his argument that it was possible 
 that the King might not recover. Whether willingly 
 or not, Warren and Willis were now definitely in oppo- 
 site camps in this bitter contest, and the debate turned 
 
 1 For the evidence of the physicians regarding the King's condition 
 see " Parliamentary History," Vol. XXVII.
 
 112 MEDICINE IX ENGLAND 
 
 upon their medical position and experience. At the 
 mention of Warren's name the party of Pitt made 
 derisive and unseemly noises, and Pitt at once stated 
 that he preferred to rely upon the opinion of Willis, 
 who had more experience of the disease than any of the 
 other physicians, while Warren had scarcely any. 
 Burke and Fox, who were friends of Warren, in reply 
 passed eloquent and stately eulogiums upon his skill 
 and character, and with regard to Dr. Willis, who was 
 so learned in insanity, they asked why Dr. Monro, the 
 superintendent of Bethlem, had not been called in, or 
 as Burke said, " Why not put one doctor of a mad- 
 house against another ? " In the end Pitt acceded to 
 this request for the appointment of a Committee of 
 twenty-one members, which took 400 folio pages of 
 evidence. 1 
 
 On January 13th the House considered this report, 
 and again the storm of party conflict revolved around 
 the question of the skill of Warren and Willis. Burke, 
 in heated but majestic language, complained that Warren 
 and Willis had been examined as if they were equal in 
 point of skill. He ended by saying that he did not 
 believe that the King's life was safe in the hands of 
 Willis, who had actually trusted a razor in the King's 
 hand. Sheridan also said that the answers of Dr. Willis 
 were most evasive and prevaricating. Of course the 
 design of this arraignment was to show that the opinion 
 of Willis, who regarded the illness of the King as tem- 
 porary only, was of little weight. Pitt, on the other 
 hand, with equal vehemence, combated this view, and 
 maintained that the evidence showed that, although 
 the King was incapable of business, the incapacity was 
 only temporary, and that, therefore, an interval merely 
 had to be provided for. With consummate ability, Pitt 
 seized upon the point that three of the physicians were 
 
 1 For the evidence given before this Committee see " House of 
 Commons Journal," 1789.
 
 DURING THE REIGN OF GEORGE III 113 
 
 conversant with the disease, but that Dr. Warren and 
 Sir George Baker were not. He pointed out that the 
 two latter only saw the King for two hours each day, 
 while the others saw him from 3 p.m. to 11 a.m., and 
 Willis more than them all. He held, therefore, that the 
 opinion of those who saw the King most frequently 
 was to be accepted, and those who were with him 
 most of all believed in his recovery. In fact, Pitt 
 supported the view of Willis and placed in him implicit 
 trust. Having thus thrown down the gauntlet, he then 
 dealt the Whigs a parting blow by hinting that Warren 
 was influenced in his opinion by a " high authority," 
 meaning, of course, the Prince of Wales. 
 
 Such was the tone of the debates so far as the phy- 
 sicians were concerned. In the end, the Regency Bill was 
 framed in accordance with Pitt's wishes, but it was never 
 put into operation, for, in March, the physicians were 
 able to declare the King recovered from his illness. 
 
 The question must now be asked How far were 
 Warren and Willis actuated by party motives in the 
 opinions they gave ? After reading the evidence given, 
 and after considering the political atmosphere which 
 surrounded the sick couch of George III, it appears to 
 be almost impossible to escape from the conclusion that 
 the opinions expressed by the two chief medical op- 
 ponents were influenced by party spirit. The private 
 associations of the two men also lend some support to 
 that view. Willis, as has been mentioned, was suddenly 
 introduced by Lord Thurlow, and this in itself was 
 suspicious. It has also been stated that Willis was a 
 strong adherent of Pitt in Lincolnshire. Warren was 
 admittedly a personal friend of Burke and Fox, a 
 member of the literary circle which drew its inspira- 
 tion from Johnson's famous club, and eventually a 
 member of the club itself. It is peculiar, also, that 
 Warren never called in a mental specialist, although in 
 evidence he admitted that he always called in one in
 
 114 MEDICINE IN ENGLAND 
 
 cases of this kind. It is true that he did consult Dr. 
 Monro, but he never called him in. Did he fear that 
 Monro would side with the other expert, Willis ? No 
 doubt the position of the physicians was most difficult, 
 and perhaps circumstances were too strong for them, 
 but after making all allowance for the delicate nature 
 of their task, the opinions given by Warren and Willis 
 can hardly be exempted from the suspicion of having 
 been tinged with political bias. 
 
 But while the House of Commons was contending for 
 the royal power temporarily relinquished by George III. 
 another contest equally bitter was being waged within 
 the royal sick-chamber. Even here the baneful in- 
 fluence of party strife made itself felt, and the position 
 was rendered more difficult by the unworthy squabbles 
 which broke out among the physicians. The regular 
 medical attendants of the King had no experience in 
 the management of a lunatic, and they hesitated to 
 submit their august patient to the ordinary methods 
 of control. The King acted as he pleased, and one night 
 when he became violent, Sir George Baker could not be 
 prevailed upon to suggest to the King that he should 
 retire for the night. Sir George did not reap any 
 advantage from his forbearance, for the King suddenly 
 seized him by the throat and pinned him to the wall. 
 With the advent of Willis, however, matters improved. 
 He understood the management of the insane, as prac- 
 tised in those days, and he applied to the King the usual 
 methods of repression and coercion. Very soon he 
 acquired an ascendency over the monarch, and al- 
 though he incurred the intense and lasting aversion of 
 his royal patient, he was feared and obeyed. By 
 degrees, the regular physicians were thrust more and 
 more into the background, and Dr. Willis, assisted by 
 his son, Dr. John Willis, assumed complete control of 
 the invalid. The King was soon removed from Windsor 
 to Kew and arrangements were made for his care and
 
 DURING THE REIGN OF GEORGE III 115 
 
 treatment. Willis did not hesitate to cause the patient 
 to be confined in a straight waistcoat when he became 
 violent, and it is probable that the King received harsh 
 treatment at the hands of Ernst, the Prussian page of 
 the back-stairs, who acted as chief attendant. The 
 stories, however, of the brutal treatment meted out to 
 George III, during his insanity, are much exaggerated, 
 and gained credence at the time chiefly through the 
 statements made by Lady Harcourt. Her evidence, 
 however, when closely inspected, is full of inaccuracies 
 and is not worthy of implicit trust. All those about the 
 King's person were genuinely sorry for his unhappy 
 position, with one notable exception, his eldest son, 
 the Prince of Wales, and he, the First Gentleman of 
 Europe, had the execrable taste to indulge his un- 
 doubted powers of mimicry at the club, in portraying 
 to his satellites the antics and ravings of his afflicted 
 father. 
 
 The supercession of the regular physicians by Dr. 
 Willis accentuated the bad feeling which already ex- 
 isted, and bitter quarrels took place over the treatment, 
 and the particular form in which the daily bulletins 
 should be issued. Willis was, of course, anxious to 
 show that the King was progressing towards recovery, 
 while Warren and the others were concerned to paint 
 his condition in more gloomy colours. To make matters 
 worse it was found that Willis was writing on his own 
 authority to Pitt, without consulting the others. On 
 one occasion Willis stated to Pitt that the King was 
 making great progress when, according to the other 
 physicians, the patient had passed a very restless and 
 violent night. Dr. Warren rightly characterised these 
 proceedings as political rather than medical. Court 
 ladies were apparently the medium for communica- 
 tions between the Prince of Wales and the physicians, 
 and on more than one occasion the Prince interfered 
 to have the bulletins altered. But the culminating
 
 116 MEDICINE IN ENGLAND 
 
 point was reached one morning when the physicians, 
 on going to see their patient, were confronted with a 
 notice pinned up in the anteroom stating that no one 
 might see the King without the permission of the 
 Doctors Willis ! Willis was in supreme authority and 
 he arranged matters as he pleased. But the medical 
 tragedy was drawing to a close ; in February the 
 King showed undoubted signs of regaining his 
 reason, and in the following month the physicians 
 were able to declare him capable of transacting business 
 again. 
 
 It cannot be said that much credit is due to the regular 
 physicians in attendance for the way in which they 
 managed the King's illness. A perusal of the evidence 
 given leaves the impression that the illness itself and 
 its treatment were- matters of secondary importance 
 when compared with the all-absorbing question of the 
 political results to be expected from the illness. Will- 
 ingly or unwillingly, the physicians, especially Warren 
 and Willis, by the opinions they expressed, served the 
 ends of violently opposed political factions, while the 
 others apparently by their silence acquiesced in the 
 course of conduct adopted. The regular physicians 
 admitted that they knew little or nothing about the 
 treatment of mental disease. Yet, when Willis had 
 been introduced, they failed to take the obvious course 
 of calling in another alienist of approved reputation for 
 their own protection. Both Simmons and Monro were 
 available, but were never summoned, with the result 
 that the King's physicians were relegated to a secondary 
 position at the command of .a man they regarded as 
 little better than a quack. It has been the fashion to 
 express contempt for the medical ability of Willis, but 
 it must not be forgotten that he alone had a definite 
 plan for the treatment of the King, that after his arrival 
 haphazard methods gave place to orderly treatment, and 
 that he, of all the physicians, was most confident in his
 
 DURING THE REIGN OF GEORGE III 117 
 
 belief that the King would soon recover, a belief that 
 was borne out by future events. 
 
 In 1801 the King became again affected, and although 
 the attack was not severe it lasted for about five months. 
 In this attack the Willis family again assumed almost 
 absolute control, and the King was constantly under 
 the supervision of either Dr. John Willis or the reverend 
 Dr. Thomas Willis, who represented their father, Dr. 
 Francis Willis, now prevented by age from being in 
 active attendance. In 1804 a third relapse took place. 
 The more acute symptoms lasted from February to 
 March, but convalescence was not established until 
 some months later. Previous to this attack the King 
 had stated his strong objection to be under the care of 
 the Willis family in case he should have another relapse, 
 and it was, therefore, arranged that he should be attended 
 by Dr. Samuel Foart Simmons, the able physician to 
 St. Luke's Hospital. Dr. Simmons proved to be an 
 excellent choice, and it is probable that for the first 
 time the King had the benefit of really capable and 
 judicious treatment. On both of these occasions he 
 was incapacitated from undertaking public business, 
 but the government of the country was carried on and 
 little was allowed to transpire concerning the illness. 
 
 In the three attacks of insanity sustained by George 
 III, an exciting cause can be found in the political 
 crises which immediately preceded them. Before the 
 first attack the King had passed through the disasters 
 which resulted in the separation of the American 
 Colonies, and to this blow was added the effect upon 
 his mind produced by the disgraceful conduct of the 
 heir-apparent with regard to his marriage with Mrs. 
 Fitzherbert. Pitt's determination, in spite of the 
 obstinate opposition of the King, to bring in a bill for 
 the emancipation of the Catholics, and his subsequent 
 resignation, were certainly largely responsible for the 
 King's second attack in 1801, and the trouble arising
 
 118 MEDICINE IN ENGLAND 
 
 out of Addington's unstable administration no doubt 
 induced the attack in 1804. 
 
 On October 25th, 1810, the King" for the fourth time 
 showed acute symptoms of insanity. Indeed, ever since 
 his last attack he had never really recovered, but had 
 been more or less peculiar in his manner. The present 
 attack was severe, and was brought on by the shock 
 the King had sustained by the death of his favourite 
 daughter, the Princess Amelia. The physicians attend- 
 ing the King on this occasion were Dr. Reynolds, Dr. 
 Baillie, Dr. Heberden the younger, Sir Henry Halford, 
 and Dr. Robert Willis. As in the first attack, they were 
 examined before the Privy Council on November 28th 
 and 29th, and before the two Houses on December 14th 
 and 17th. The evidence was interesting, for all the 
 physicians were convinced that the King, although he 
 had had three previous attacks and was in his seventy- 
 second year, would recover, and probably soon. They 
 were pressed to say what experience they had of a 
 man at that period of life recovering, and could 
 give none. Baillie and Heberden bluntly told the 
 Committee that they had no experience of mental 
 disease, while Halford and Reynolds relied on the cases 
 they had seen in private practice. The only expert was 
 Willis, who had succeeded his father, and it was strange 
 that no other specialist was called in. Politics played 
 no part in this examination, for all parties were agreed 
 that a Regency was the only possible way out of the 
 difficulty. The examination cost Reynolds his life, for 
 he was unequal at his time of life to the exertion of 
 standing for hours while giving his evidence. He 
 never recovered from the fatigue and died very soon 
 after. Contrary to the expectations of the physicians, 
 the King never regained his reason, and, after passing 
 ten years in this sad state, died in 1820. 
 
 While George III, aged, helpless, and insane, was 
 dying in seclusion in England, in a far-off sea-girt isle
 
 DURING THE REIGN OF GEORGE III 119 
 
 death was about to claim the most remarkable example 
 of brain energy that the world has ever produced. For 
 in St. Helena, the great Napoleon, a prisoner, and stripped 
 of all earthly power, was on the point of making his 
 exit. As in the case of George III, his illness is an 
 example of the evil of allowing politics to be blended 
 with the practice of medicine. Indeed, it is not too 
 much to say that Napoleon's complaint was misjudged 
 throughout, almost entirely on account of political 
 influences which obscured the judgments of the 
 medical attendants. It was not the British Authorities 
 only who were responsible for the introduction of 
 politics, for Napoleon himself was equally to blame. 
 The chief question at issue between the French at 
 Longwood and the British Authorities was not the 
 precise nature of the malady of the Emperor, but rather 
 how far climatic influences were responsible for its 
 onset. Whether or not Napoleon suffered from attacks 
 of hepatitis induced by the climate is a debatable 
 subject, but as to the cause of his death there can be no 
 dispute. He died of cancer of the pylorus, which 
 remained undiagnosed until the post-mortem examina- 
 tion was made, although disease of the stomach was 
 surmised a few days before he died. Situated as he was. 
 Napoleon had not at his command medical assistance of 
 a very high order, for the surgeons who attended him 
 were of mediocre talents, and excessively fearful of 
 compromising their position by the expression of 
 medical opinions contrary to the official views. 
 
 The lot of kings when stretched upon a bed of sick- 
 ness is far less enviable than that of humbler mortals. 
 Politics and the august presence of royalty seem to 
 conspire together to paralyse the efforts of physicians, 
 and it may be doubted if the prognosis in cases of illness 
 among kings can ever be regarded in so favourable a 
 light as in those of more lowly beings. The same 
 remarks do not, however, apply to great figures in
 
 120 MEDICINE IN ENGLAND 
 
 literature. Indeed, they appear to be able to command 
 all the ability and sympathy of the physicians who 
 attend them. The case of Samuel Johnson illustrates 
 this point, and probably no man was ever treated during 
 his illnesses with such tenderness and ungrudging 
 solicitude by physicians of eminence, who often held 
 opinions widely at variance with those of their patient. 
 
 All his life Johnson possessed a warm personal 
 regard for doctors. Many of his friends belonged to 
 that profession, and he had written the lives of Boer- 
 haave, Garth, and Akenside. Several physicians had 
 even enjoyed the honour of being elected members of 
 the literary clubs over which Johnson exercised sway. 
 To the club in Ivy Lane Drs. McGhie, Barker, and 
 Bathurst belonged, while at the more celebrated one at 
 " The Turk's Head " in Gerrard Street, two physicians, 
 Dr. George Fordyce and Dr. Nugent were among the 
 members. Besides these, several physicians were close 
 friends of Johnson, and foremost among them were 
 Dr. Thomas Lawrence, Dr. Richard Brocklesby, and 
 Dr. Robert James. For Lawrence, who was a dis- 
 tinguished President of the College, Johnson had a 
 warm affection, and it was in Lawrence's consulting- 
 room that one of the most extraordinary consultations 
 took place. Mrs. Piozzi relates the incident, which 
 occurred in 1781 when Johnson, who was suffering from 
 asthma and dropsy, sought the advice of his friend. 
 It so happened that Lawrence had recently been 
 attacked with hemiplegia and aphasia, and both patient 
 and physician were extremely hard of hearing. In 
 these circumstances any idea of a consultation was out 
 of the question, so, seeing the humour of the situation, 
 they occupied their time by writing punning sentences 
 in Latin to each other. 
 
 There was another reason also for the delight Johnson 
 took in the society of doctors. He was a keen amateur 
 student of medicine, and took the greatest interest in
 
 DURING THE REIGN OF GEORGE III 121 
 
 his own ailments. His robust temperament made him 
 a strong believer in drastic remedies as opposed to 
 palliatives. The physician could never give Johnson 
 too violent a remedy, and if he faltered the patient made 
 him aware of it by some taunt. In this way he showed 
 his displeasure at the cautious treatment of the great 
 Heberden by referring to him as " timidorum timidis- 
 simus." Another habit of Johnson when ill was to 
 supplement the efforts of the physicians by strong 
 measures of his own, and, as we shall see, this ill-judged 
 interference in the end cost him his life. 
 
 For many years the health of Johnson was robust, 
 and, with the exception of fits of depression, it could 
 not be said that he suffered from ill-health. As years 
 advanced, however, he began to be troubled with 
 symptoms of bronchitis and emphysema. Breathless- 
 ness on exertion became particularly troublesome, and 
 his nights were disturbed by cough, inability to assume 
 a recumbent position, and severe attacks resembling 
 asthma. By the time he had passed the age of sixty 
 other symptoms pointing to grave interference with the 
 circulation, such as palpitation, giddiness, and swelling 
 of the legs, began to make their appearance. For the 
 bronchitis the usual remedies were prescribed, and 
 particularly squills in large doses, but Johnson seemed 
 to obtain more relief from ample and repeated vene- 
 sections. Opium in large doses was effectual in cutting 
 short the attacks of asthma, but he soon became aware 
 of the danger of continuing its use, and after having 
 taken as much as four grains in a single dose he had the 
 courage to abandon the practice. 
 
 Johnson continued to be troubled with these symp- 
 toms until June 16th, 1783, when a serious event took 
 place. On that night he went to bed as usual, but in a 
 short time was aroused with, as he described it, " con- 
 fusion in the head," and was alarmed to find that he had 
 lost the power of speech. His mental faculties, however,
 
 122 MEDICINE IN ENGLAND 
 
 were not much impaired, for he could put a prayer into 
 Latin, and could think and reason without difficulty. 
 Although he had not completely lost power of the move- 
 ments of the right hand, he experienced great difficulty 
 in forming the letters when he tried to write a letter. 
 This letter, which was a request to his friend Dr. Taylor 
 to obtain the assistance of Drs. Heberden and Brock- 
 lesby, is in existence, and shows, only too plainly, that, 
 in spite of Johnson's assertion, his mental faculties were 
 impaired by the attack. It contains several repetitions 
 of words, and exhibits curtailment of the power to 
 express thoughts. 
 
 While he was waiting for the arrival of the doctors he, 
 as usual, decided to treat himself, and, as he said, " to 
 rouse the vocal organs " he took two glasses of wine. 
 Heberden and Brocklesby now arrived, and at once 
 noticed that Johnson's face was drawn to one side. 
 He had so far recovered that he could speak, though 
 indistinctly, and could repeat fairly well the Lord's 
 Prayer. The doctors learning that the attack was 
 passing off, gave a good prognosis, and their opinion was 
 justified, for on the second day the paralysis had dis- 
 appeared, and by the fourth day he had entirely 
 recovered the use of speech. 
 
 But although Johnson recovered from this attack, it 
 was, in fact, the beginning of diseased conditions which 
 were soon to terminate his life. Towards the end of 
 1783 dropsy supervened, and the legs and thighs 
 swelled up to an enormous extent. He became seri- 
 ously alarmed at his state, and set apart a day for 
 fasting and humiliation. To his joy he had the satis- 
 faction of seeing the water in his legs disappear as if by 
 magic. In fact, in twenty-four hours he voided over 
 twenty pints of urine. It must, however, be mentioned 
 that besides the day of fasting and humiliation, Johnson 
 had been taking quantities of diuretics, and perhaps 
 some would argue that these drugs had as much to do
 
 DURING THE REIGN OF GEORGE III 123 
 
 with the happy result as the treatment by way of 
 penance. In any case, the dropsy which had persisted 
 for 120 days was gone, and now, with the exception of 
 a slight cough, he enjoyed a measure of health for a 
 limited period. 
 
 About this time he did a most unwise thing. Although 
 he had at his command the skill of the ablest medical 
 men that London could produce, and among them were 
 such great names as Heberden, Baker, Pepys, Warren, 
 and Brocklesby, he was persuaded by Boswell to 
 consult by letter the great medical authorities in 
 Edinburgh. He, therefore, detailed the symptoms of 
 his case to Cullen, Alexander Dick, Gillespie, and 
 Monro. The result was what might have been expected. 
 They indicated a line of treatment which interfered with 
 that adopted by the London physicians, and Johnson's 
 time was largely employed in taking incredible quantities 
 of drugs. 
 
 In 1784 the dropsy returned, and the stomach began 
 to show signs of derangement. Liberal doses of squills 
 and other diuretics produced some remission, and he 
 was in no great distress until November 8th, 1784, when 
 the dropsy became again formidable. From July 6th 
 to November 8th of this year Johnson recorded his 
 symptoms in a journal, and it is a faithful, if melancholy, 
 account of his last days. But he was now on his 
 death-bed, and the end was to take place very soon. 
 The dropsy had assumed such enormous proportions 
 that Mr. Cruikshank, at the earnest solicitation of 
 Johnson, was requested by the physicians to make 
 incisions in the legs and scrotum to let out the water. 
 This operation was performed on December llth, and 
 on the morning of the 13th Johnson ordered his servant 
 to hand him a lancet, and with his own hand he made 
 the cuts deeper. In this operation about ten ounces 
 of blood were lost, but it was more than the en- 
 feebled constitution of Johnson could bear. He soon
 
 124 MEDICINE IN ENGLAND 
 
 began to sink, and before the day was out he was no 
 more. 
 
 Few men, whatever their position in the world, have 
 been attended with such unselfish devotion and con- 
 sideration. For the physicians who cared for Johnson 
 it was a labour of love, and their attitude on this 
 occasion constitutes one of the bright pages in the 
 history of our profession. Macaulay has stated that 
 the ablest physicians placed their skill at Johnson's 
 disposal and refused to accept fees. That is true, but 
 although moribund, Johnson insisted that a copy of 
 " The Lives of the Poets " should be placed in the 
 coach of each of the distinguished physicians as he left 
 the house. 
 
 In connection with the illness and death of Johnson, 
 the library of the College of Physicians possesses a 
 document of the greatest interest in the form of the 
 original report of the post-mortem examination, in the 
 handwriting of the operator, Mr. James Wilson. This 
 document has, it is true, been published in 1849 in the 
 " London Journal of Medicine," but since it is little 
 known, and not very accessible, it may be transcribed. 
 It is as follows : 
 
 " Wednesday, December 15th, 1784, opened the body 
 of Dr. Samuel Johnson for Mr. Cruikshank, in the 
 presence of Drs. Heberden, Brocklesby, Butler, Mr. C., 
 and Mr. White. He died on Monday preceding. About 
 a week before his death Mr. C. by desire of his 
 physicians aAtiificcd his legs and scrotum, to let out 
 the water which was collected in the cellular membrane 
 of those parts, Dr. Johnson being very impatient to 
 have the waters entirely gone. On the morning of the 
 day he repeated the operation himself and, cutting very 
 deep, lost about ten ounces of blood ; he used a lancet 
 for this purpose ; he was in too weak a state to survive 
 such an apparently trifling loss. For several years past 
 he had been troubled with asthma, for which he com-
 
 DURING THE REIGN OF GEORGE III 125 
 
 monly used to take opium, and found that nothing 
 else was of any service to him ; he had discon- 
 tinued, however, this practice some years before he 
 died. 
 
 " On opening the cavity of the chest, the lungs did 
 not collapse as they usually do when air is admitted, but 
 remained distended, as if they had lost the power of 
 contraction ; the air-cells on the surface of the lungs 
 were also very much enlarged ; the right lobe adhered 
 very strongly to the diaphragm ; the internal surface of 
 the trachea was somewhat inflamed ; no water was 
 found in the cavity of the thorax. The heart was 
 exceedingly large and strong, the valves of the aorta 
 were beginning to ossify ; no more fluid than was 
 common was contained in the pericardium. In the 
 abdomen seemed to be incipient peritoneal inflammation 
 and ascites ; the liver and spleen were firm and hard ; 
 the spleen had almost the feel of cartlidge. A gall stone 
 about the size of a pigeon's head was taken out of the 
 gall bladder ; the omentum was exceedingly fat ; 
 nothing remarkable was found in the stomach ; the 
 folds of the jejunum adhered in several places to one 
 another ; there was also a strong adhesion by a long 
 slip between the colon and bladder ; the pancreas was 
 remarkably enlarged ; the kidney of the left side 
 tolerably good, some hydatids beginning to form on its 
 surface ; that of the right side was almost entirely 
 destroyed, and two large hydatids formed in its place. 
 Dr. Johnson never complained of any pain in this part ; 
 the left testicle was perfectly sound in structure, but 
 had also a number of hydatids on its surface, containing 
 a fatty gelatinous fluid, the right testicle had hydatids 
 likewise, but the spermatic vein belonging to it was 
 exceedingly enlarged and varicose. The cranium was 
 not opened. 
 
 " N.B. Mr. White, assisting me to sew up the body, 
 pricked his finger with the needle ; the next morning he
 
 126 MEDICINE IN ENGLAND 
 
 had red lines running up the arm, and a slight attack of 
 fever." 
 
 The illnesses responsible for the deaths of eminent 
 Georgians may often be traced to habits, particularly 
 common to that age, of inordinate eating and drinking. 
 A prominent case of this kind is that of Charles James 
 Fox, who was in reality a victim of his own generous 
 and warm-hearted disposition. His upbringing is well 
 known ; how at an early age he was encouraged to 
 drink, gamble, and indulge in every kind of wild 
 debauchery by that detestable father, Henry Fox, the 
 first Lord Holland. The wonder is that so much of the 
 noble and chivalrous nature of Charles Fox was pre- 
 served after such a terrible tutelage. His constitution 
 must have been splendid. Up to within two years of his 
 death he was a complete stranger to serious illness, and 
 used to boast that a dose of sulphur was sufficient to 
 remove all the ills he had ever known. Most of his 
 nights were spent in gambling at the club, where he 
 consumed oceans of wine, or in the House of Commons, 
 where his vigour and powers of declamation were 
 equalled only by those of Pitt. Until the fifty-fourth 
 year of his age no impairment of health was noticeable, 
 but already the pace had begun to tell, and Fox was 
 about to pay the debt to outraged nature. 
 
 In 1804, while at Cheltenham, he complained of a 
 feeling of discomfort over the liver, and was advised to 
 consult a doctor. A peculiarity of his, however, was a 
 strong dislike to speak of his ailments, and still more to 
 allow a medical man to examine him. About a year 
 after this, Lord Lauderdale called his attention to the 
 fact that his abdomen and legs were very swollen. Fox 
 then confided to his friend that for some time past his 
 appetite had failed, that his strength was feeble, and 
 that he was troubled with sickness in the morning. 
 David Pitcairn, Halford, and Moseley were consulted 
 and pronounced the disease to be dropsy. This was
 
 DURING THE REIGN OF GEORGE III 127 
 
 self-evident, and was, of course, due to cirrhosis of the 
 liver induced by intemperate living. The accumulation 
 of water in the peritoneal cavity became so con- 
 siderable that it was deemed necessary to have recourse 
 to tapping, and on Fox's removal to Chiswick a second 
 operation became imperative. On September 7th, 1806, 
 he became much worse, and soon relapsed into a mori- 
 bund condition. In this state he remained until the 
 13th, when he expired. At the post-mortem examina- 
 tion it was found that the liver was in an advanced state 
 of cirrhosis, the natural consequence of the irregular life 
 he had led. 
 
 In fact, the end of brilliant Charles Fox was similar to 
 that of the common gin-drinker in the back slums. While 
 we deplore the irregularities of his life, we still have in 
 grateful remembrance his manful fight against political 
 oppression, and our sympathies are still moved by the 
 memory of his life-long championship of civil and 
 religious liberty. Perhaps Fox would not be so near to 
 our hearts to-day had he been a paragon of spotless 
 virtue. 
 
 The end of Fox's great Parliamentary rival, the 
 austere and immaculate Pitt, took place in the same 
 year, but much obscurity surrounds his illness. There 
 can be no doubt that over-indulgence in alcoholic liquor 
 was in part responsible for Pitt's condition, for all his 
 life he was immoderately fond of port wine. Since 
 Addington recommended liberal quantities of this wine 
 to counteract the weakly constitution of Pitt when a 
 child, responsibility for the habit thus encouraged must 
 rest in part upon that physician's shoulders. Then gout, 
 which laid a heavy hand on all the male members of 
 Pitt's family, did not spare him. To these adverse 
 conditions must also be added the terrible mental strain 
 produced by the unsuccessful struggle in which the 
 country was engaged with Napoleon, and when Auster- 
 litz appeared to be the grave of European liberty, the
 
 128 MEDICINE IN ENGLAND 
 
 enfeebled constitution of Pitt sank under the blow, and 
 death became imminent. At about that time he began 
 to waste rapidly, and the stomach rejected the lightest 
 form of nourishment. After a protracted journey from 
 Bath to Putney which caused his physician, Sir Walter 
 Farquhar, much anxiety, Dr. Baillie was called in, and 
 the gravity of the case was clearly recognised. Remedies 
 were of no avail, and in a few days the patient died. It 
 is impossible now to assign the actual cause of death, but 
 the opinion may be hazarded that Pitt suffered from 
 malignant disease, or chronic ulcer, of the stomach. 
 
 The cases narrated above are examples of the famous 
 patients attended by physicians in the reign of George 
 III. Space does not permit of the list being extended, 
 but perhaps the instances given will serve to stimulate 
 interest in this special branch of the history of medicine. 
 It must be remembered that the arrangements in the 
 sick-room in those days were not such as we are ac- 
 customed to expect at the present time. Skilled nursing 
 was unknown, the sanitary conveniences were neglected, 
 and fresh air was regarded as harmful. Frequently the 
 patient was allowed to rest on a couch, until increasing 
 weakness compelled him to take to his bed, and a con- 
 siderable latitude was permitted with reference to the 
 kind of nourishment taken. 
 
 In concluding this review of the state of medicine 
 during the reign of George III, some considerations may 
 be advanced concerning the advantages of a study of 
 the history of medicine. 
 
 In recent years the study of this subject has made 
 great progress, and at most centres, both here and on 
 the Continent, its investigation has become almost a 
 recognised branch of medicine. 
 
 Although the days have long since passed when the 
 mere mention of medical history raised a smile of genial 
 sarcasm, many of us would be glad to see a still wider 
 interest shown in the subject. Sound arguments may
 
 DURING THE REIGN OF GEORGE III 129 
 
 be advanced in support of this desire. At the present 
 day, the immense range covered by the word 
 " medicine " leaves but little time for the cultivation of 
 extraneous studies which both elevate the mind and 
 increase its usefulness in human life and endeavour. For 
 this reason the title of " physician " is not now so 
 synonymous with culture as it was in former years. 
 Indeed, with the multifarious duties which fall to the 
 lot of physicians in these days, it is wellnigh impossible 
 to expect of them a wide and profound acquaintance 
 with subjects outside the sphere of their immediate and 
 pressing work. But a study of the history of medicine 
 would permit the physician, while still tethered to his 
 life work, to roam in a wide circle into the realms of 
 history, biography, philosophy, and all the activities of 
 the human mind. It would, at least, be a hobby, and so 
 long as a hobby does not overwhelm the main purpose 
 in life, it implies no disgrace, but rather operates as an 
 agent of high recuperative value. 
 
 It has been urged that a study of this subject cannot 
 advance our knowledge of present-day medicine. That 
 may be true. But how can knowledge of any part of 
 medicine be complete without an investigation of the 
 early steps taken from hypothesis to accepted fact. 
 The Church, the law, politics, art, and science all have 
 their histories. Why should medicine, the meeting- 
 point of all human emotions, lag behind ? 
 
 If medical history be deemed worthy to form part 
 of the education of physicians, surely no more fitting 
 place can be found for its abode than the College of 
 Physicians, the ancestral home of physicians for four 
 centuries. The College has founded the FitzPatrick 
 Lectures for the purpose of encouraging the study of 
 the history of medicine, and is thus the first medical 
 body in this country to accord recognition to this par- 
 ticular subject. The connection between the College 
 and medical history is of the most intimate nature,
 
 130 MEDICINE IN ENGLAND 
 
 and it is impossible for those belonging to it to remain 
 uninfluenced by its great traditions. There everything 
 around reminds them of the history of British medicine. 
 On the staircase, in the reading-room, and in the 
 Censors' room they gaze on the portraits of physicians 
 who have laboured to advance the knowledge of medicine. 
 The choice and magnificent library contains rich stores 
 contributed by the great master-builders of the past. 
 At the College meetings the Fellows occupy seats once 
 filled by their great predecessors, Heberden, Baillie, 
 Arbuthnot, Friend, Young, and Bright. The Presi- 
 dential Chair recalls to them the long line of dis- 
 dinguished physicians who have adorned that eminent 
 position, down to the present occupant who has done 
 so much to encourage learning and the study of the 
 history of medicine. It is a great heritage, and in proof 
 of its vitality, it need only be stated that, while dynasties 
 and empires have risen and crumbled in decay, the Royal 
 College of Physicians is still, after four centuries, at the 
 full tide of its strength and influence. 
 
 We cannot afford to neglect the study of this branch 
 of medicine. Veneration for those who have laboured to 
 perfect the knowledge of our art, and the desire to be 
 exactly informed concerning their work make it in- 
 cumbent upon us to include this subject among those 
 required for a complete medical education.
 
 APPENDIX 
 
 THE STATISTICS OF THE MEDICAL 
 PROFESSION 1760-1820
 
 A DETAILED STATEMENT OF THE NUMERICAL 
 STRENGTH OF THE PROFESSION IN 1782 
 
 Physicians Resident in London . . 149 
 
 Surgeons ...... 274 
 
 Apothecaries . . . . . .351 
 
 774 
 
 Practitioners Resident in the Provinces . 3560 
 Practitioners Resident in Wales . . 125 
 
 3685 
 
 Total in England and Wales . . 4459 
 
 (Reference, "Medical Register," 1783.) 
 
 133
 
 THE NUMERICAL STRENGTH OF THE 
 PROFESSION 
 
 Area Year Population . Prac- Propor- 
 
 titioners tion 
 
 England & Wales 1782 7,814,827 4459 1 in 1752 
 London 650,845 774 1 in 840 
 
 England & Wales 1911 36,070,492 25,472 1 in 1416 
 London 4,521,685 6,415 1 in 705 
 
 In 1817 it was estimated that 1098 medical prac- 
 titioners were resident in London, which then had a 
 population of 1,100,000, which gives a proportion of 
 about one medical man to 1000 people. 
 
 Since no correct census of the people was taken before 
 1801 the numbers given before that date are estimates 
 only. 
 
 (References, "Medical Register," 1783. 
 The Census Returns. 
 " A Picture of the College," 1817. 
 " Porter's Progress of the Nation.") 
 
 134
 
 THE COMPOSITION OF THE COLLEGE 
 OF PHYSICIANS 
 
 Fellows 
 
 In the West End 
 In the City 
 Elsewhere 
 
 1746 
 
 54 Licentiates . . 24 
 
 7 In the West End . 7 
 
 34 In the City . . 13 
 
 13 Elsewhere 4 
 
 (An Address to the College, 1747.) 
 
 Fellows 
 
 1753 
 41 Licentiates 
 
 (See "A Letter from a Physician, 1 ' 1753.) 
 
 1782 
 
 Fellows . . .43 
 
 In the West End . 18 
 
 In the City . . 8 
 
 Elsewhere . 17 
 
 Licentiates 
 
 In the West End 
 In the City . 
 Elsewhere 
 
 42 
 
 74 
 24 
 27 
 23 
 
 (See "Medical Register," 1783.) 
 
 1817 
 
 Fellows . . .89 
 
 In the West End . 38 
 
 In the City . . 7 
 
 Elsewhere . 44 
 
 Licentiates . . 224 
 
 In the West End . 67 
 
 In the City . . 25 
 
 Elsewhere . 132 
 
 (See " A Picture of the College," 1817.) 
 
 135
 
 THE CREATION OF FELLOWS AND 
 LICENTIATES 
 
 Year Fellows Licentiates 
 
 admitted admitted 
 
 1760-9 17 56 
 
 1770-9 13 30 
 
 1780-9 17 79 
 
 1790-9 21 54 
 
 1800-9 25 98 
 
 1810-19 35 99 
 
 Total for 60 years . .128 416 
 
 Annual Average . .2.1 6.9 
 
 136
 
 FACILITIES IN LONDON FOR MEDICAL 
 INSTRUCTION, 1783 
 
 Lectures on the Theory and Practice of Physic, and 
 
 Materia Medica. 
 
 Dr. Fordyce, at his house in Essex Street, Strand. 
 Dr. Saunders, at Guy's Hospital. 
 Dr. Haddocks, at the London Hospital. 
 
 Clinical Lectures. 
 
 Dr. Fordyce, on cases of patients at St. Thomas's 
 
 Hospital. 
 Drs. Saunders and Keir, on cases in Guy's and 
 
 St. Thomas's. 
 
 Dr. Maddocks, on cases in the London Hospital. 
 Dr. Simmons, on cases at the Westminster General 
 
 Dispensary. 
 
 Lectures on Diseases of Children. 
 
 Dr. Andrew Wilson, at his house in Beaufort Buildings. 
 
 On Animation. 
 
 Dr. Hawes, at his house in Great Eastcheap. 
 
 Chemistry Lectures. 
 
 Dr. Fordyce, at his House in Essex Street. 
 
 Drs. Saunders and Keir, at Guy's Hospital. 
 
 Dr. Maddocks, at the London Hospital. 
 
 Dr. Bryan Higgins, at his house in Greek Street, Soho. 
 
 Philosophy of Chemistry and Natural History. 
 Dr. Henry Moyes, at Mr. Walker's in George Street, 
 
 and at the Plasterer's Hall, Aldermanbury. 
 T 137
 
 138 MEDICINE IN ENGLAND 
 
 Lectures on Anatomy and Dissections. 
 
 Mr. Cruickshank, at Great Windmill Street. 
 
 Dr. R. Maclaurin, at his house in Mark Lane. 
 
 Mr. Blizzard, at the London Hospital. 
 
 Mr. John Sheldon, at his house in Great Queen Street. 
 
 Mr. H. Cline, at St. Thomas's Hospital. 
 
 Lectures in Midwifery. 
 
 Drs. David Orme and Lowder, at Dr. Lowder's, 
 
 St. Saviour's Churchyard. 
 Dr. John Leake, at his house in Craven Street. 
 Drs. William Osborne and Thomas Denman, in 
 
 Leicester Street. 
 Dr. Robert Bland, at his house in St. Alban's Street. 
 
 Lectures in Surgery. 
 
 Mr. Percival Pott, at St. Bartholomew's Hospital. 
 
 Mr. John Hunter, in the Hay market. 
 
 Mr. J. O. Justamond, in Macclesfield Street, Soho. 
 
 Lectures on the Teeth. 
 
 Mr. W. Rae, at Mr. Hunter's lecture room in the 
 Hay market. 
 
 Natural Philosophy. 
 
 Mr. Walker, at his House in Great George Street, 
 Hanover Square. 
 
 (See "Medical Register," 1783, by S. F. Simmons, 
 p. 50.)
 
 A LIST OF PERIODICAL PUBLICATIONS 
 DEVOTED TO MEDICINE DURING THE 
 REIGN OF GEORGE III 
 
 ANNALS OF MEDICINE. Edited by Andrew Duncan. 
 Vols. 1-3. Edinburgh, 1796-1804. 
 
 ANNALS OF MEDICINE AND SURGERY. Vols. 1-2. 
 London, 1817-18. 
 
 EDINBURGH MEDICAL AND SURGICAL JOURNAL. Estab- 
 lished in 1805. 
 
 ESSAYS AND OBSERVATIONS. Vols. 1-3. Edinburgh, 
 1770-71. 
 
 LONDON MEDICAL JOURNAL. By a Society of Physicians. 
 Vols. 1-11. London, 1781-90. 
 
 Dr. Simmons was the first editor. 
 
 LONDON MEDICAL REPOSITORY. Vols. 1-20. London, 
 1814-23. After 1823 it was continued as the 
 LONDON MEDICAL AND SURGICAL JOURNAL, and 
 survived until 1836. The title of Vol. 1 of the new 
 series was the LONDON MEDICAL, SURGICAL, AND 
 PHARMACEUTICAL JOURNAL, and in 1825 it became 
 the LONDON MEDICAL REPOSITORY AND REVIEW. 
 
 LONDON MEDICAL, SURGICAL, AND PHARMACEUTICAL 
 REPOSITORY. Vols. 1-29. London, 1814-28. 
 
 LONDON MEDICAL AND SURGICAL SPECTATOR. Vols. 
 1-2. London, 1808-9. 
 
 MEDICAL AND CHIRURGICAL REVIEW. Vols. 1-15. 
 London, 1795-1807. 
 
 139
 
 140 MEDICINE IN ENGLAND 
 
 MEDICAL COMMENTARIES. Edited by Andrew Duncan. 
 Edinburgh, 1780-95. 
 
 MEDICAL COMMUNICATIONS of the Society for Promoting 
 Medical Knowledge. Vols. 1-2. London, 1784-90. 
 
 MEDICAL ESSAYS AND OBSERVATIONS. Vols. 1-5. 
 1737-44. Continued to 1757. Published in Edin- 
 burgh. 
 
 MEDICAL ESSAYS AND OBSERVATIONS. Abridged from 
 Memoirs of the Royal Academy of Sciences, Paris. 
 4 vols. London, 1764. 
 
 MEDICAL FACTS AND OBSERVATIONS. A continuation 
 of the LONDON MEDICAL JOURNAL. Vols. 1-8. 
 London, 1791-1800. 
 
 MEDICAL MUSEUM. Vols. 1-3. London, 1763-4. 
 
 MEDICAL OBSERVATIONS AND ENQUIRIES. By a Society 
 of Physicians of London. Vols. 1-6. London, 
 1757-1812. 
 
 MEDICAL AND PHILOSOPHICAL COMMENTARIES. By a 
 Society of Physicians of Edinburgh. London, 
 1774-95. 
 
 MEDICAL AND PHYSICAL JOURNAL. London, 1799-1833. 
 This Journal was re-named the LONDON MEDICAL 
 AND PHYSICAL JOURNAL. 
 
 MEDICAL RECORD AND RESEARCHES. Selected from the 
 Papers of a Private Medical Association. London, 
 1798. 
 
 MEDICAL SPECTATOR. Vols. 1-3. London, 1791-96. 
 
 NEW MEDICAL AND PHYSICAL JOURNAL. Or " Annals 
 Medicine and Surgery and Collateral Branches." 
 Vols. 1-10. London, 1810-15. 
 
 NEW LONDON MEDICAL JOURNAL. Vols. 1-2. London, 
 1792-93.
 
 DURING THE REIGN OF GEORGE III 141 
 
 SOCIETY FOR THE IMPROVEMENT OF MEDICAL AND 
 CHIRURGICAL KNOWLEDGE. Vols. 1-3. London, 
 1793-1812. 
 
 TRANSACTIONS OF THE COLLEGE OF PHYSICIANS. Vols. 
 1-6. 1767-1820. 
 
 TRANSACTIONS OF THE MEDICAL SOCDZTY. 
 TRANSACTIONS OF THE MEDICO-CHIRURGICAL SOCIETY.
 
 PRINTED BY 
 
 WILLIAM BRRNDON AND SON, LTD. 
 PLYMOUTH, ENGLAND
 
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