Internet Archiveopen access

Dr. John Fothergill and his friends; chapters in eighteenth century life;

..^•"'v.

UBRARY JRVINE

DR. JOHN FOTHERGILL AND HIS FRIENDS

MACMILLAN AND CO.. Limited

LONDON . BOMBAY • CALCUTTA • MADRAS MELBOURNE

THE MACMILLAN COMPANY

NEW YORK • BOSTON • CHICAGO DALLAS ■ SAN FRANCISCO

THE MACMILLAN CO. OF CANADA. Ltd.

TORONTO

Digitized by tine Internet Archive

in 2007 witii funding from

IVIicrosoft Corporation

littp://www.arcliive.org/details/drjolinfotliergillOOfoxriala

tr^IllnJi>tw^ pk ■

DR. JOHN FOTHERGILL

AND HIS FRIENDS^

CHAPTERS IN EIGHTEENTH CENTURY LIFE

Rf HINGSTON FOX, M.D.

MACMILLAN AND CO.," LIMITED ST. MARTIN'S STREET, LONDON

1919

r793

Let us preserve the memory of the deserving : perhaps it may prompt others likewise to deserve. The human mind requires every incitement to look up to its Original : to think it is not made for this world only. Great is the prize, and worth contending for.

Dr. John Fothergill, 1769.

Multum egerunt qui ante nos fuerunt, sed non peregerunt : multum adhuc restat operae.

Seneca.

COPYRIGHT

TO LOVERS OF

KNOWLEDGE, TRUTH, AND LIBERTY

IN THE OLD WORLD

AND THE NEW

PREFACE

Dr. John Fothergill was a London physician, a man of science, a Quaker and a philanthropist, and one who had special relations with the American pro- vinces before and during the War of Separation.

The friends of Dr. Fothergill of whom an account is given in this work are chiefly the following :

his medical friends, Dr. John Aikin, Dr. George Cleghorn (Dublin), Dr. William Cuming (Dorchester), Baron Thomas Dimsdale, Dr. William Falconer (Bath), Dr. Anthony Fothergill (Bath), Dr. William Hunter, Dr. John Coakley Lettsom, Dr. Thomas Percival (Manchester), Dr. Alexander Russell, Dr. John Rutty (Dublin), Dr. Gilbert Thompson :

his scientific friends,

John Bartram (Philadelphia),

William Bartram (Philadelphia),

Peter Collinson,

Mendez Da Costa,

Humphry Marshall (Pennsylvania),

Dr. Joseph Priestley :

vii

viii PREFACE

his Quaker and philanthropic friends, David Barclay, Samuel Fothergill, John Howard ;

and his other American friends, Dr. Benjamin Franklin, William Logan, Dr. John Morgan, James Pemberton, Dr. Benjamin Rush, Dr. Benjamin Waterhouse.

The names of many other friends of Fothergill, who receive a shorter notice, will be found in the Index.

Dr. Fothergill was a man of wide interests. In order to render the picture of his life and influence as complete as possible, the author has combined a notice of his medical activities with his other pursuits, notwithstanding that the former may seem to be too technical for inclusion in so general a work. Portions of the chapters on his medical work have already been read before the Royal Society of Medicine and the Hunterian Society, or have been included in papers published in the Practitioner and the Lancet.

The sources of information are stated in footnotes, especially at the end of a chapter. The bibliography and the manuscript sources are more fully dealt with in the Appendix, where also will be found the text of the Conciliation Proposals for preventing the American War, 1774— 1777, now printed from the original documents.

The author has pleasure in acknowledging the help received from many correspondents, medical, scientific, Quaker and some in the United States, who have supplied references and details ; these will be found noted in their

PREFACE ix

proper places. To members of his own family he owes a debt beyond all ; for without their patient assistance the book could not have been written.

This volume is put forth at a time of strife, when men's thoughts are full of the toils and struggle of war. It may be well at such an epoch to be reminded of what our fathers were thinking and doing in times of strain and battle and loss, albeit on a lesser scale than ours. And we may perhaps gain some help in meeting the problems of our day, the age-long questions that beset the lot of humanity : how to control evil in the world, how to ensure justice, and the nature and the limits of the law of love.

36 Devonshire Place,

London, W. i,

1918.

CONTENTS

PACK

Preface . . . . . . . vii

CHAPTER I

The Eighteenth Century ....

Brief outline of some leading features of British life in this century, social, political, literary, religious, medical — Dr. John Fothergill's place in the century.

CHAPTER II

Dr. John Fothergill — Birth and Training

Birth of Fothergill at Carr End, Wensleydale, 17 12— The house and scenery of the dale — Fothergills of Ravenstonedale — Dr. Thomas Fothergill of Queen's College, Oxford ; Dr. J. Milner Fothergill and other notable members of the elder stock— John Fothergill of Mallerstang, 1665 — George Fox in Wensleydale, 1652 — John Fothergill of Carr End, an austere Quaker, father of Dr. John Fothergill — His ministry in America — He meets Washington's grandfather — A County Election at York, 1734 — Fothergill's mother — His brothers and their descendants — Dr. Samuel Fothergill of London — Fothergill's education — Sedbergh School — Apprenticeship to Benjamin Bartlett at Bradford, 1728 — B. Bartlett, the younger — Fothergill enters Edinburgh University, 1734 — The journey thither on horseback — Edinburgh of those days — Origin of the Medical School — Dr, Archibald Pitcairne — Dr. Alexander Monro primus— Yiis colleagues, pupils of Boer- haave at Leyden — Fothergill's description of his teachers — His manner of study — He takes his medical degree, 1736 — Journey to London by sea — Pupil at St. Thomas's Hospital- He settles in London as a physicina — Visit to the Netherlands and Germany, 1740 — The Moravians.

xii CONTENTS

CHAPTER III

I'AGE

Outline of Fothergill's Life in London . .18

White Hart Court — Fothergill's care for the poor — Visits patients with apothecaries — Licentiate of the College of Physicians, 1744 — His treatise on the ulcerated sore throat, 1748— Great increase of his practice — Abortive thoughts of marriage— His sister Ann Fothergill joins him, 1754 — His many friends — Scientific work — Botanical garden at Upton, 1762 — Fellow of the Royal Society, 1763 — He takes a country house, Lea Hall, Cheshire, 1765 — Removal from the city to Harpur Street, 1767 — Dr. Lettsom — Medical Societies — He is proposed as a King's physician, 1774 — He recommends Dr. Dimsdale to the Empress of Russia, 1768 — Philanthropic work — Aids to literature — Anthony Purver and his Bible, 1764— Friendship with Franklin — Fothergill's ties with Pennsylvania — His peace work, 1774, 1775-

CHAPTER IV

Fothergill as a Physicl'^n — His Work in Thera- peutics . . . . . .30

Causes of his great success in medical practice : his insight, rapidity, tenacity, kindness — A visit to a patient, described by Barbara Hoyland — His thorough training : a follower of Boer- haave — State of Therapeutics in his time — The old traditions of polypharmacy giving way — Venice Treacle and Mithridate — Fothergill's influence in the rational use of remedies — One of the best prescribers of his age — Researches into many drugs — Letters to Professor Alston — London without a university — Persian Manna — Kino — Catechu — Winter's bark — Sassafras, etc. — Chemical remedies — Mineral waters of Buxton, Bristol, etc. — Antimony — History of the use and disuse of this drug : Basil Valentine : the French school — Examples of Fothergill's pre- scriptions.

CHAPTER V

Fothergill's Medical Practice. A Case in Con- sultation . . . .

Tropical diseases — Emulsions — ^James Bogle-French — Hemlock — Cinchona bark — Treatment of gout — Fothergill's letters of advice — Some of his patients — Wesley — Lord Clive — A case in con- sultation with Dr. Cuming — Fothergill's tactful discouragement of bleedings and multiple drugs — His favourite lines of treatment — Emphasis on Digestion — His hours of practice — Library.

41

CONTENTS xiii

CHAPTER VI

PAGE

The Malignant Sore Throat . . . -49

Fothergill's study of the epidemic sore throat of 1747 — His treatise, outlining former outbreaks, symptoms and treatment — A model of clinical description — Putrefaction and antiseptics — The disorder was a form of scarlatina — Evolution of the group of throat fevers — Reform in treatment due to Fothergill.

CHAPTER Vn

Fothergill's other Medical Writings . . -55

The use of Emetics^ — Ruptured diaphragm : Congenital syphilis — Sciatica — Tubercular meningitis — Tic douloureux — Hydro- phobia— Epilepsy — Bleeding in Apoplexy — Sick headache — English habits of diet — The use of coffee — Dropsy — Consump- tion— The climate of London — The management of the climacteric — Obesity — Angina pectoris — Pigment poisoning — Ipecacuanha in diarrhoea — Influenza : Fothergill's schedule for collective investigation — Relation of weather to disease : four years' obser- vations— Rules for the preservation of health, a spurious work.

CHAPTER Vni

The Dispute with Dr. Leeds . . . -74

Dr. Samuel Leeds, an Edinburgh graduate — Fothergill's opinion of his want of skill — Leeds' misfortunes, and charges against Fothergill — A Quaker arbitration — Fothergill declines the verdict — The case carried to the law courts and decided in his favour — Relations with the Parkinsons.

CHAPTER IX Baron Dimsdale — Inoculation for Smallpox , 79

Origin of inoculation — Lady Mary Wortley Montagu — Opposi- tion to the practice^ — Fatality of smallpox — The Suttons — Dr. Thomas Dimsdale — His origin and family— The Cockfields— Invasion of the Young Pretender, 1745- — Lord Lovat — Dims- dale's inoculation methods at Hertford — A furore for the opera- tion— The Empress Catherine II. — She sends to London for an inoculator, 1768 — Fothergill recommends Dimsdale — His journey to Petersburg — Detailed account of his visit — Courage and generosity of the Empress — A brilliant court — Some test cases — Dimsdale's anxiety — Secret inoculation of the Empress by

xiv CONTENTS

night — Good results. — Universal joy of the people — Inoculation of the Grand Duke and of others — Dimsdale created a Baron and highly honoured — Text of the patent of nobility — Visit to Moscow, and to Frederick the Great — Return to England — Con- troversy with Dr. Lettsom — Second visit to Russia, 1781 — Dimsdale as banker and Member of Parliament — His character — After-history of inoculation — Dr, Hay<^arth — Infection by a medical wig — Vaccination — Inoculation prohibited, 1840 — Patho- logy of inoculated smallpox and vaccinia.

CHAPTER X

Dr. Lettsom . . . . . -99

Birth of Lettsom, 1744, in the West Indies — Education at Pen- keth, Lancashire — Apprenticed to Abraham Sutcliff — Introduc- tion to Fothergill — Study in London — Akenside — Lettsom re- visits Tortola — Liberates his slaves — Returns and studies in Edinburgh — Enters on practice in London — His foibles — Marriage — Popular repute — His work on fevers — Founds the Medical Society — Paper on hard drinking — Scientific pursuits — Botany — Minerals — The mangold wurzel — His numerous "Hints" — "Dr. Wriggle" — A day of societies — The Sea Bathing Infirmary, Margate, 1796 — Lettsom's large income and lavish generosity — Reclaims a highwayman — Lettsom's habits of life — His elegant literary style — Dr. Johnson — Lettsom's villa at Camberwell— Its gardens and adornments — Poems by his friends — He fights Jenner's battles for vaccination — Griefs of his later life — Serene closing years — Death in 18 15 — His character as a Quaker of liberal views — Loved by his friends — His debt to Fothei^ll — Lettsom's house in Bolt Court — The Isis tablet.

CHAPTER XI

Other Medical Friends .....

Dr. Alexander Russell, physician and naturalist, of Aleppo, later of St. Thomas's Hospital, London — His work on fevers.

Dr. George Cleghorn of Minorca, afterwards Professor of Anatomy in Dublin — His letters to Fothergill — Book on Minorca and its diseases.

Dr. William Cuming of Dorchester — A county physician of high esteem and liberal pursuits.

Dr. Gilbert Thompson of London— A Quaker, cultivated, classical, diffident.

Dr. John Rutty of Dublin — An incessant student — Writings on hydrology, on the weather, on natural history and on materia medica — His introspective Quaker Diary.

Dr. William Hunter of London, a great lecturer.

CONTENTS XV

PACJK

Dr. Anthony Fothergill of Northampton and Bath, a younger friend and protege of John Fothergill — Researches on restoring animation.

Dr. Thomas Percival of Manchester — Medical ethics — Magee's encomium.

Dr. William Falconer of Bath.

Dr. John Aikin of London — The Warrington Academy.

CHAPTER XII

The Rise of Medical Societies in Britain . .137

(i.) Early Scientific Societies. The Medical Society (of Physicians) — Rise of scientific societies : in Italy : in England, -the Royal Society, 1660 : in France, Germany, etc. : in America, 1743 — Medical Societies: in Edinburgh, 1731 — "Medical Essays and Observations " — Royal Medical Society of Edinburgh, originated by students, including Fothergill, 1734 — He founds the Medical Society (of Physicians) in London, 1752 — Its leading members — "Medical Observations and Inquiries," 1757 — "Medical Transactions" of the College of Physicians, 1767.

(ii.) The Society of (Licentiate) Physicians. Revolt OF the Licentiates of the Royal College of Physicians of London, 1765 — Constitution of the College and selection of the Fellows, chiefly from Oxford and Cambridge — Position of licentiates, with Scottish or continental degrees, and often dissenters- — Attempts at reform of the College — Fothergill's first effort, 1752 — Lord Mansfield's opinion — Fothergill heads the licentiates in the Revolt of 1765 — Letter to Sir Fletcher Norton — Account of the licentiates concerned — Disorderly scenes — Sir William Browne and his derisive language — Failure of two lawsuits — The sequel — Proposal of Fothergill as Fellow, 1771- — The small Society of (Licentiate) Physicians, 1767.

(iii.) The Medical Society of London — One of many medical societies of this period — Its foundation by Lettsom, 1773 — His enlightened aims — A group of young men — Rules of the Society — The Library — Difficulties in early years — Lettsom presents the Society with a house, 1788 — Issue of Transactions, 1789 — Medley's painting — The Fothergillian gold medal — Later history of the Society, the first to be constituted on a liberal basis.

CHAPTER XIII

Botany in the Eighteenth Century : Peter Collinson,

John Bartram . . . . -157

Ray — Linnaeus — Peter Collinson — Sir Hans Sloane — John Bartram and his botanic garden — Long correspondence with Collinson — Bartram's searches, and adventures in the American

xvi CONTENTS

PAGE

backwoods — Perils from the Indians — Visits to Florida — Collin- son's titled friends — List of the seeds of trees and plants yearly sent to England — The introduction of American trees to British parks — Lord Petre — The Dukes of Richmond — The Goodwood cedars— The Hanbury cedars at Coggeshall — Water tortoises and mud turtles — Outline of Bartram's life and character — Story of his garden — CoUinson's garden, now occupied by Mill Hill School — Account of the trees still standing — His intro- ductions— Letters to Linnaeus — The migration of swallows — Work in the Royal Society — Collinson leads Franklin to experi- ment in Electricity — Fothergill publishes Franklin's first treatise — Generous recognition of Franklin by the Royal Society — CoUinson's person and character — The onset of spring in his garden — Fothergill on Collinson.

CHAPTER XIV

Fothergill as a Botanist — His Garden . .182

The pursuits of Fothergill — Early botanic gardens in Britain — Fothergill's garden at Upton, 1762 — His collectors abroad — William Bartram, field botanist and artist — His five years' wanderings in the Southern American provinces — Extracts from his Travels : The variety of vegetable nature ; the instinct of tendrils ; the language of birds ; an adventure at the Isle of Palms ; rencontre with a Seminole Indian ; how to treat the Indians — Humphry Marshall, another Quaker botanist — Fother- gill's "Directions for taking up Plants and conveying them by Sea " — His American border at Upton — Nelumbium, the great water-lily of the Delaware — The tea-tree — Use of tea — Jonas Hanway and Wesley — The tea flowers in Fothergill's garden, 1774 — Chinese Ginseng — Jllicium, the starry Anise — Arbutus Andrachne — Story of the barrel of earth from Borneo — Paintings of plants in full bloom — Sale after Fothergill's death — Upton under Samuel Gurney — The present West Ham. Park — A recent visit : Fothergill's trees — Some of his chief introductions to Britain — Linnaeus names the genus Fothergilla.

APPENDIX TO CHAPTER XIV List of Plants introduced by Dr. John Fothergill . 203

CHAPTER XV

Fothergill's other Scientific Interests . . 208

Papers for the Royal Society — The origin of amber, 1744 — Thomas Story on the Scarborough cliffs — Paper on Siberia, 1748

CONTENTS xvii

PAGE

— Fossils — Martin Lister and Lhuyd — Fothergill presents their manuscripts to the University of Oxford — His plans for a review of the rise of Natural History in England — Indolent state of the University — Huddesford — Corals — John Ellis — Fothergill's marble table — His collection of shells — He befriends Mendez Da Costa — The "Chinese Pheasant" — Insects — Henry Smeath- man, his collector in West Africa — The ill-fated settlement at Sierra Leone — Chinese Silk — Dr. Gowin Knight's magnetic machine — Fothergill's aid to Priestley — Observations on rain — The use of pictures.

CHAPTER XVI Fothergill as Philanthropist and Social Reformer 218

Philanthropy, false and true — Fothergill's universal benevolence — His delicacy — Generosity to his patients — A London curate — Fothergill's use of money — Instances of his bounty — Attitude to moral causes — Slavery — ^John Woolman — Scheme for a colony in Africa — Prison reform — John Howard — Proposal to employ convicts in sawing stone — Fothergill as supervisor to establish penitentiaries — Subscription in aid of French prisoners — Fother- gill's paper on recovery from apparent death, 1745 — Societies for the recovery of the drowned, 1767 — Dr. Hawes — Dr. Cogan — The Royal Humane Society — Registration of births and deaths — Fothergill's effort for reform, 1754 — Defeat of the Bill in Par- liament— Use of potato flour in time of scarcity — Fish brought to London by land carriage — Canals — John Hustler — Efforts of Fothergill in the reform of London, to widen its streets, to pre- vent fires, to prohibit sugar factories, to regulate burial, to pro- mote bathing.

CHAPTER XVII

The Society of Friends in Fothergill's Early Days 235

Epoch of Fothergill's birth, 1712 — Declension firom the pristine virtue of the early Friends — Change in the note of the yearly epistles : order rather than power — Toleration Act — The Friends, a quiet body set apart — "Marrying Out" — Literary activity — " Public Friends" — Character of the ministry.

CHAPTER XVIII

Samuel Fothergill . . . . -239

Younger brother of the doctor — Wayward early life — His reclama- tion and call to the ministry — Intimacy of the brothers— A fine personality — The polished orator of the society — His visit to

xviii CONTENTS

America, 1754 — Hardships and labours — State of P'riends in the provinces — Revival of the discipline — Crowded meetings — Boston, the Aceldama of the Quakers — Political troubles in Pennsylvania — S. Fothergill's part — Return home — Samuel Em len — S. Fother- gill a preacher of reputation — His associates — Declining health — Fervent addresses of his last years — Farewells — Grief of his brother — Person and character of S. Fothergill — His ideal of the ministry — Epigrams and metaphors — A prophetic figure.

CHAPTER XIX Fothergill as a Member of the Friends . -251

Fothergill as a Friend — The habit of quiet communion — An elder — Clerk to the yearly meeting — Laxity in the society — The Com- mittee of Reformation, 1760 — The epoch of the elders — The rules of discipline — A strait fence : a system — Summary of Quakerism drawn up by the two Fothergills — Character of the eighteenth- century Friend — His scruples — His virtues — Influence of wealth — Atmosphere of the Quaker household — Fothergill a strict Friend — Ridiculed in a play — His example in education and philanthropy.

CHAPTER XX Home Life in London ..... 263

Diary of a niece visiting Fothergill and his sister — Their home — Dr. Lettsom at breakfast — Barclays, Gurneys and the best Quaker society — Fothergill's ways at home — His conversation — Ann Fothergill — The numerous meetings — Sober recreations — Sights of London — Wilkes — The King — Lord Mayor's Show — Fields in London — Fogs — The House in Harpur Street, Bloomsbury.

CHAPTER XXI David Barclay ...... 269

The Barclays a great Quaker house — Robert Barclay and his "Apology" — David Barclay of Cheapside — Visit of the King and Queen, 1761 — David Barclay the younger — His marriage — Instructions for his daughters' training : religion, moral virtues, dress, behaviour, etc. — Agatha Barclay — Her marriage and early death — Barclay's work with Fothergill — Liberation of slaves — Other philanthropic labours — His fine character — Hudson Gurney,

CONTENTS xix

CHAPTER XXII

PAGE

AcKwoRTH School . . . • .278

Education among the early Friends — Labour school at Clerken- well — Low state of education in Fothergill's days — Anthony Benezet — Governor Berkeley — The yearly meeting's efforts — Proposal of Ackworlh — The house purchased — Friends' approval — A large subscription^ — The first superintendents — The school opened, 1779— Fothergill's visit — Letter to Priestley — Percy's " Key" — Barclay's co-operation — Letter from the boys' monitors — Success of the school — T. Scattergood — Pilkington — A model to Friends in Ireland and America : Providence, New York, Westtown, etc. — A guarded education — Schools for the poor — Joseph Lancaster — Verses on Ackworth centenary — Ackworth to-day.

CHAPTER XXIII

Pennsylvania, the Quaker Colony . . . 290

Friends in the rise of the American colonies — Their share in the government — Rhode Island — The Jerseys — William Penn — His frame of government and laws — Political parties in Pennsyl- vania-— The Friends in control — Quaker attitude towards war : E. Burrough ; Barclay ; Penington ; Fox — John Archdale — Position of a (Quaker governor— War taxes in Pennsylvania — James Logan.

CHAPTER XXIV

FOTHERGILL AND QUAKER RULE IN PENNSYLVANIA,

174I TO 1756 ..... 298

The "Meeting for Sufferings" in London — Fothergill as a member — Committee on the affairs of Pennsylvania — Fothergill's connection with the colonies — Governor Thomas's complaint, 1740 — Deputations of Quakers — James Logan on defensive war — Fothei^ill's letter— The Pemberton family — James Pemberton's word — William Logan — Dr. George Logan — His chivalrous effort for Peace — Difficulties of the Quaker Assembly — An un- democratic position — Revolt of the Indians, 1754 — Critical state of the province — Defeat of Braddock — Wrath against Quakers — Mediation of the London Friends — Fothergill's action — A Bill to disqualify Quakers — War with the Indians — Fothergill and others advise Friends to resign — William Callender — End of the seventy years of Quaker government — Fothergill and Lord Hyde — Friends' labours for the Indians — The epoch of Quaker govern- ment not a failure — Position of Friends in the province — The Quietist phase.

XX CONTENTS

CHAPTER XXV

PACK

FOTHERGILL AND FRANKLIN, 1 7 57 TO 1 774- REVOLT OF

THE American Provinces , . . • 3M

Franklin comes to England, 1757 — Friendship with Fothergill — Comparison of the two men — Letter from Franklin, 1764 — Dispute with the proprietary Penns — Franklin in England again — The Whig Club — The Stamp Act, 1765— Fothergill's pamphlet on the American colonies — His account of Franklin's examination before Parliament, 1766 — Repeal of the Act — Franklin's position and influence — More taxes — Trouble at Boston, 1770 — Franklin's use of private letters, 1773 — Wedderburn's invective — Fother- gill's indignant words on the situation, 1774.

CHAPTER XXVI

The Conciliation Proposals, 1774, 1775 • • 323

Franklin in London — Policy of Lord North — The votes in Parliament — George IIL — The pro- American party — John Wesley — Lord Chatham — North's real character — Lord Dart- mouth— Could nothing more be done ? — A chess party — Lord Hyde and David Barclay — Franklin approached — A triumvirate in Fothergill's study — An earnest conference — " Hints for Con- versation " under seventeen heads — A tactful compromise — Franklin's generosity — The paper goes to the Cabinet — Lord Howe's efforts — Fothergill writes to Pemberton — Chatham's motion — A Cabinet meeting — Lord Sandwich denounces Franklin — " Remarks on Hints " — Franklin's indignation — Fothergill writes to Dartmouth : failure of the negotiation — He urges Repeal of the Acts — Barclay's new " Plan " — The Ministry acts : coercion, then conciliation — Last conference with Franklin — Fothergill's despair of British liberty — Character of conciliation effort.

CHAPTER XXVH

The Early Years of the War of Separation, 1775 to

1777 . . . . .338

Franklin's departure — His Voyage — Lexington and Bunker's Hill — Quaker appeal to the King, headed by Fothergill — Position of Friends in the colonies — No part in " Commotions " — John Dickinson and legal methods — Fothergill remonstrates with the Pennsylvanian Friends — Rachel Wilson — The "Olive Branch" — Indians in the war — Fothergill's fresh effort, Oct. 1775 — Willing to go to America as a mediator — Barclay's news from the Front — Indignant letter to Hyde, 1776 — Lord Howe sent out — Hopes of Peace — Declaration of Independence— No Quaker

CONTENTS XXI

PAGE

Signatories — Friends as Tories — The Free Quakers — Sufferings pf the Friends — War relief funds — Franklin in Paris — A great figure — Correspondence in war-time.

CHAPTER XXVIII

Fothergill's Work in War-time, 1777 to 1780 348

The American cause depressed — The British in Philadelphia, 1777 — Fothergill's message — Surrender of Burgoyne — Fother- gill's letter to Franklin— His estimate of the King — A dark prospect — Pleads for a commercial union — Lists of fame and infamy— Abolition of oaths as a reproach to truth — Credit versus ready money — Barclay's plan of conciliation, 1777 — Letter from Fothergill on overtures to Franklin at Paris — The Conciliation Bill, 1778 — Too late — Further course of the war — Chatham — Burke — Distress at home — An enemy fleet in the Channel, 1779 — Movement for Reform — Wyvill and the Yorkshire Association — Fothergill's letter for the meeting at York — His pamphlet, " An English Freeholder's Address," in the year of his death, 1780 — Peace at length, 1783 — Last letters between Franklin and Fothergill — The Countess of Huntingdon — Fothergill's proposal for a College of Justice — Penn's essay — John Bellers — A League of Nations — Weights and measures — Franklin's estimate of Fothergill — The last years of Franklin — The Fothergill Cup — Reflections on the war — Was it inevitable ? — Fothergill's attitude : its justification^ — The conciliation effort vindicated.

CHAPTER XXIX

Fothergill and the Medical Institutions of America 366

Philadelphia physicians from the early days — The Pennsylvania Hospital, 1 75 1 — Fothergill's aid to American students — Dr. Shippen — The Fothergill anatomical pictures — Dr. Morgan, founder of the Medical School — His Introductory Discourse — The young professors, 1765 — Fothergill's care for the Hospital — Dr. Benjamin Rush — The Sydenham of America — Rush's career and character — King's College, New York — The Pennsylvania Land Company — Fothergill secures the funds for the Hospital — Dr. B. Waterhouse — First Professor of Medicine at Harvard — A great vaccinator.

CHAPTER XXX

Fothergill's Closing Years .... 377

Lessening powers — Cares and burdens of Fothergill's later years — Illness, 1778 — Ackworth — His father's grave — Dr. Carmichael Smyth and gaol fever — Last visit to Ackworth School — Illness and death, 1780 — Funeral at Winchmore Hill — Ann Fothergill, died 1 802 — Fothergill's will — Sale of his library.

xxii CONTENTS

CHAPTER XXXI

PACE

Character of Fothergill .... 384

Fothergill's person, dress and habits— His intelligence, emotions, temper, conscience — Common sense, insight, initiative — The relief of suffering — Zeal for knowledge — A clouded epoch — W. Hunter — Esther Tuke — War-time conditions — Influences that formed Fothergill's character : inheritance ; Edinburgh Uni- versity ; his friendships ; America ; Franklin ; Peter CoUinson ; his patients — His contributions to his century : in medicine ; in science ; in philanthropy ; in politics — Reliance on a higher Power — The Valhalla of medicine.

APPENDIX A

Text of the Documents of the Conciliation Pro- posals, 1 774-1 777, now first fully given from THE originals ..... 393

APPENDIX B

Letter of Advice to a voung Patient by Dr. John

Fothergill ...... 409

APPENDIX C

Letter from Samuel Fothergill to a young Woman

a short time before her marriage . -413

APPENDIX D

Biographical and Manuscript References, Portraits,

Busts .-vnd Personal Relics . . .416

INDEX . , . . . . .423

LIST OF ILLUSTRATIONS

Portrait of Dr. John Fothergill. Photogravure from oil

painting by Gilbert Stuart (see p. 419) . . Frontispiece

Monogram used by Dr. John Fothergill on his silver

plate, etc. ..... .Title-page

FACING PAGE

Portrait of Dr. John Fothergill. Photogravure, by permission of the Royal College of Physicians of London, from oil painting by W. Hogarth (see p. 420) . .18

A Medical Consultation : Drs. David D'Eschemy, Antony Addington, and John Fothergill. From a caricature sketch by George Dance (see p. 421) . . . 45

Portrait of Baron Thomas Dimsdale, M.D. From a mezzo- tint engraving preserved at the Friends' Reference Library, London . . . . .79

Portrait of Dr. John Coakley Lettsom. Reproduction of an engraving by Ridley, after an oil painting by Medley. From the original plate in the possession of Mr. T. C Colyer-Fergusson ....

Portrait of Peter Collinson. From an engraving by S. Trotter prefixed to Fothergill's Account of P. Collinson .

99

157

Friends' Meeting, Gracechurch Street, London. Photogravure

from oil painting (see p. 262) .... 262

Portrait of David Barclay. From an engraving by Earlom after Houghton, by permission of the Committee of the Friends' Institute, London . . .• , 269

Ackworth School. Reproduction of an old print, by permis- sion of Frederick Andrews . . . .278 xxiii

xxiv LIST OF ILLUSTRATIONS

FACING PAGE

Portrait of Dr. Benjamin Franklin. From an oil painting by Joseph Wright, 1782, reproduced by permission of the Royal Society (see p. 179) . . . .314

Facsimile Extract from a Letter from Dr. John Fothergill to William Logan, Pennsylvania ; dated from London, 1 8th March 1775 (see p. 342) .... 342

One of the Fothergill Pictures : a Series of Anatomical Draw- ings presented by Dr. J. Fothergill to the Pennsylvania Hospital, 1762 (see p. 368) .... 368

Portrait of Dr. John Fothergill. Reproduction from a Medallion

by Wedgwood (see p. 420) .... 384

CHAPTER I

THE EIGHTEENTH CENTURY

Examine the past, take from it all that is beautiful, and on it create the future. — President Kruger.

The eighteenth century is to many people not an attractive epoch in history. It has been called matter- of-fact, in spite of its sensibilities : there was little romance : " poetry and wonder lay fast asleep on Ida's shady brow." The stirring events of the preceding age in England were followed by a reaction, the high tide of revolution by a backwater, which lasted through several generations. British liberty was content to abide the illiberal rule of the earlier Hanoverian kings, and material aims were frankly dominant : the vice and gluttony of the richer circles seem to justify Carlyle's caustic comment : " Soul extinct ; stomach well alive." But under this show of things the nation itself was still growing : vast territories were brought under British rule in the course of this century : inventions were many, and industries grew and multiplied : wealth increased, and became more diffused ; and this led to the rise of the middle class of society. The influence of Bacon and NeWton was bearing fruit in a keen appetite for know- ledge ; many modern sciences owe their birth to this period. Education began to be spread slowly, the newspaper came into vogue, and thought was emanci- pated by degrees from the shackles of tradition. The way of democracy was being made ready ; its birth was heralded in France by terrific convulsions, but in our own country the long struggle against the absolutism of

2 THE EIGHTEENTH CENTURY chap.

the third George was conducted on constitutional lines to a successful issue ; and the British nation, chastened by the loss of her greatest colonies, and by long European war, emerged from its conflicts unhurt, ready for all that was to open before the world in the next age.

Art and literature were subject in the eighteenth century to a classical renaissance, and the love of beauty found expression in set forms. Wit of an artificial kind sparkled in conversation and in letters. But freedom of thought and the light of science must lead sooner or later to naturalism in the whole range of knowledge, and ere the century closed this had begun to show itself in art and even in literature. Nor must the strong and stately English prose, of which Johnson was only the chief amongst many masters, be forgotten. Religion was traditional, theological, systematic, and, it must be added, too often gloomy : the true Church slept under forms and shows and a low standard of morals. Men of independent thought were apt to cast off faith entirely, or to take refuge in a vague Deism. But there was always a leaven of faithful men and women better than their churches : the nonconformists grew in number ; and the great Wesleyan revival came as a sorely needed stimulus to the dulled conscience of the time. Influenced by a truer moral sense, many men entered on social and philanthropic work towards the end of the century, the era of Howard and of Wilberforce.

The science and art of medicine shared to the full in the changes which were going on in the eighteenth century. The increase of knowledge, the emancipation of thought, the rise of naturalism — these helped to set medicine free from the traditions of the past, and enabled her to build, upon the sure foundation of anatomy and what we now call physiology, a new science of medicine. Observation and induction were the means by which she built, and the dicta of the ancients came to take a lesser and lesser place as the science grew. Authority and tradition, revered through many ages, were slow to lose their hold, but all through this epoch of time the work begun by

I THE EMANCIPATION OF THOUGHT 3

Harvey and Sydenham in the previous age was carried steadily forward, under leaders of whom Boerhaave and the brothers Hunter were some of the chief. It is true that the new knowledge, following the genius of the time, was cast into systems : these had their day and passed, but the knowledge remained. If we contrast the teaching of the best physicians and surgeons at the beginning of the century — let us say of Boerhaave and Cheselden — with the teaching of Baillie and Abernethy one bundled years later, the change seems indeed to be far less than that which followed in the next age. Yet it was great, and greater in the science than in the art which is its outcome : true foundations had been laid, and a noble structure was to be reared upon them.

Dr. John Fothergill and his friends took a worthy part in the advances of the eighteenth century. Fother- gill touched life at many points. As a physician, he helped to bring into EngHsh medical practice the new spirit of natural medicine. As a man of science, he extended the boundaries of knowledge, and brought the riches of the animal, and even more of the vegetable world to light. As a lover of justice and of liberty, he had strong sympathy with the American people : he did what he could to aid their growth, and he essayed to stand with Franklin in the breach, to stay the onset of the war of separation. As a philanthropist and a social reformer, and as a pioneer in education, he was a shining example to his age. Lastly, as a member of the Friends, during the Quietist phase of the Society, he took a leading part in shaping its poUcy and influence on both sides of the Atlantic.

CHAPTER II

DR. JOHN FOTHERGILL — BIRTH AND TRAINING

I know my ancestors are bound up in me. We shame them if we fail in courage and honour. Is it not so ? Why, that makes us what we are ; we dare not be weak if we would. — George Meredith.

No man is born into the world whose work is not born with him. — - Lowell.

His boyhood had been passed in the atmosphere of the Society of Friends — that intangible but pervading spirit, which instils rather than teaches the doctrine of the equaUty and brotherhood of men and women, of rich and poor ; the nothingness of worldly distinctions ; and the supreme duty of humane conduct. — G. M. Trevelyan on John Bright.

John Fothergill was born in Wensleydale, Yorkshire, on the 8th of March 1712. Like William and John Hunter, he came from the class of small yeomen, once common in Britain, and which has furnished in the course of her history so many men of independent thought and action to take part in the national life. To find Fothergill 's birthplace we must pass up Wensleydale, where broad grassy slopes on either hand lead to moorland heights beyond, and near Bainbridge we must turn into a side valley, to the little lake of Semerwater, fed by a stream flowing from the hills above. Here, separated from the lake by low meadows, stands the plain stone farmhouse of Carr End, half hidden by trees, with its back set against a rocky scar. On a slab over the garden gateway, and upon a small stone trough, are still to be seen the marks of the builder of the house : " J. F., 1667." ^

* Carr End was the property of the Fothergill family for about two hundred years until it was sold in 1841 : it now belongs to F. H. Jackson of Middlesborough, and is occupied by J. Outhwaite. The house is in good preservation. There is a stone party-wall more than 4 feet in thickness, which contains in its substance, besides fireplaces, many ingeniously devised

4

CHAP, n SCENERY OF WENSLEYDALE 5

In this quiet spot, far from the busy haunts of men, Fothergill was bom, and here he must have spent his early boyhood. He would roam along these dales and climb the fells, and visit the waterfalls hidden in their wooded clefts. He would seek the sheep in the high pastures, then unwalled, and help perhaps to fetch peat from the bogs on the sumniit. He knew the labours of haytime, and the toil of the cheese-press. Often he would watch the moving patch of sunshine that travels along the hillside, often listen to the curlew's scream as it circles about the fell top in summer, and often gaze at the cattle standing deep in the water of the lake to cool •their feet. The face of the heavens in this hill country is ever changing, and its changes form a chief topic of thought and speech. Sunrise and sunset, the fair sky that favours the shepherd's toil, the masses of cloud that darken the earth, the storms that come from west or from east — ^these seem to be on a grander scale, and to be more instinct with life and movement, among the hills than in the lowland or the town. All the imagery of the eighth Psalm, in praise of the Power behind Nature, might have been taken from Wensleydale. Old legends, too, cling to the dark shapes of rock or mountain. Did not giants once on AddJebrough and on Stake Fell hurl great boulders at one another ? The Carlow Stone lies where then it fell at the foot of the lake, A wandering beggar's curse tells of the time when a town stood in the dale :

Simmer water rise. Simmer water sink. And swallow all the town. Save yon li'le house.

Where they gave me meat and drink.

cupboards, 'cabinets, desk, etc., also a small " tinder box cupboard " on the first floor. The fine curved staircase at the back seems to belong to Dr. Fothergill's time, and may have been added at his instance and expense : the house was mortgaged to him in 1778. The original wooden beams of the " houseplace " and other low rooms on the groimd floor remain : the roof of the upper floor has been raised. The eastern end of the house, with separate staircase, is said to have been added for a certain John Fothergill on his marriage. There is a description of the house, vinder the name of Scar Foot, and of the surroimding scenery, in a well-known tale. Kith and Kin, written by Jessie Fothergill, grand-daughter of the last Fothergill owner of Carr End, and published in 1881. She died at Berne in 1891.

6 FOTHERGILL'S BIRTH AND TRAINING chap.

The " little house," degraded to a barn, still stands lonely by the eastern shore.

It is a place of distances, where the eye ranges over bare hills and into grey skies, until it seems to grow one with what it looks upon. The men of the moorland sometimes live closer to the heart of things than the men of the city. They are strong, too, and self-reliant, for it is by hard toil that they must win her fruits from the dear earth. The old ballad of Flodden Field tells of the muster of the warlike wights of " Wensdale " :

With lusty lads, and large of length, Which dwelt at Seimer water side.^

The name of Fothergill is of old standing ; " Fother " is said to be a Scandinavian folk name, whilst " gill " signifies a rocky streamlet. Sir George Fothergill, a Norman born, was one of William the Conqueror's generals, and was with him when he took York in 1068 : he was rewarded with a grant of land in Westmorland, and married, it is said, a lady dowered with the manors of " Sedber and Garsdale." His descendants filled various offices of state in succeeding centuries, and the families of Fothergill dwelling in the small secluded valleys of Ravenstonedale and Mallerstang in this county during the past three or four hundred years are not improbably of the same stock. Some of the old Fother- gill homes stand yet in Ravenstonedale : Brownber is a sixteenth-century farmhouse with ancient latticed windows : Tarnhouse was rebuilt in 1664.

When Quaker history opens, we find a young man called John Fothergill at " Molerstang " early convinced by James Nayler. J. Fothergill became a well-furnished minister among the Friends, and laboured much in several parts of England. Haled out of a peaceable meeting at Guildford in 1665, he was committed to prison in Southwark, and, to save the constable's trouble, travelled

^ The Ballad of Flodden Field, A Poem of the XVIth Century. Ed. by C. A. Federer, 1884, p. 49.

II THE FOTHERGILL STOCK 7

thither alone bearing his mittimus with him. After some months he died in the prison of a fever.

From Westmorland, one John Fothergill is said to have migrated eastward to Wensleydale soon after the year 1600. He may well have come from Castlethwaite in Mallerstang, under the dark mass of Wild Boar Fell ; there were Fothergills here dwelling on their own land until recent times. In 1652 George Fox visited the neighbourhood. " I came upp Wensydale," he writes in his Journal, " & after passt uppe ye dales, waminge people to feare God & declaring his truth to y"" ... & some was convinced & stands to this day." In fact the Quaker faith was well received by the dalesmen, and this district became a stronghold of the Friends. Men of independent mind, prone to contemplate and to turn inward, they cherished here an unfettered conscience, bearing fruit in pure and steadfast lives and in the kindly help of their brethren. If the bleak lonely hills and inexorable skies ministered to a deep faith in the unseen, is it wonder if sometimes that faith was a little stem, a Httle chill ? 1

^ Drake, Eboracum, p. 217 ; J. H.Tuke, Sketch of J. Fothergill; C. Thornton, etc., The Fothergills of Ravenstonedale ; The First Publishers of Truth, ed. by N. Penney, pp. 162, 248, 272 ; Swarthmore MSS. Transcript, iv. 364 ; Geo. Fox, Journal, Camb. Ed. i. 40, 41. From the Westmorland Fothergills have come not a few men of learning and ability. Thomas Fothergill, master of St. John's College, Cambridge, founded in 1668 a free school in Ravenstone- dale. Anthony Fothergill of Brownber, who died 1761, was a theological writer and a man of " integrity of heart." George Fothergill, D.D. (b. 1705, d. 1760), was Principal of St. Edmund's Hall, Oxford ; and his brother Thomas, bom 1715, was Provost of Queen's College, Oxford, from 1767 to his death in 1796. The latter was a learned and singular man — " Old Custom4ry " was his familiar name — he would not, it is said, " have been seen abroad minus his wig and gown for a dukedom." The tale is told that when the college was devastated by a fire in 1778, and Mrs. Fothergill and the family had with difficulty escaped the flames, the doctor could nowhere be foimd, until at the last he emerged from the burning pile, full dressed as usual, having stayed to robe at the risk of his life. See Letters of R. Radcliffe and John James, ed. by M. Evans, Oxford Hist. Soc, 1888, p. 269. Elizabeth Gaimt, the Anabaptist martyr, and the last woman to be burnt at the stake in England {1685), was a Fothergill of Ravenstonedale. Of Anthony Fothergill, M.D., an account will be given in another chapter. John Milner Fothergill, M.D., Edin., 1865, was a physician in Henrietta Street, London. He was bom in 1841 and died in 1888 ; his works on Digitalis and other therapeutical topics are well known. The Milner Fothergill Gold Medal of the University of Edinburgh was instituted in his memory. Sfr William Fothergill Cooke (died 1879), one of the inventors of the electric telegraph, owned a maternal

8 FOTHERGILL'S BIRTH AND TRAINING chap.

John Fothergill, the builder of Carr End, was con- vinced as a Friend, perhaps as early as the time of George Fox's first visit : he died in 1684. To the house and farm succeeded Alexander Fothergill, a faithful witness to Quaker faith : he lay in prison at York for six months on account of his testimony against tithes. His eldest son, John Fothergill, the father of the doctor, was then but eighteen years of age, and thus while still a youth had to take sole charge of a motherless family, and to manage the farm and servants : his father, too, died a year later. This John Fothergill, who was bom in 1675, was deeply exercised in spiritual things from his boyhood, and early took part in the ministry of the meeting at Countersett. Amid searchings of heart and humbling of soul, his call to this service sounded yet clearer. Soon after his twentieth year he found means to be released from much worldly cares, and gave most of his time, with the approval of his friends, to religious visits, at first near home and then farther away. He thus travelled often and widely, returning to work in his own and his neighbours' fields, until such time as duty led him forth again. Three times between 1706 and 1737 he visited the American colonies, spending several years in laborious journeys through the sparsely settled regions, and gather- ing the Friends and others together to wait reverently on the Lord and to learn of Him. At Mattocks in Virginia, in the seventh month, 1721, a meeting was held, so he tells us, " at Justice Washington's, a friendly man, where the love of God opened my heart towards the people." This was Lawrence Washington, the grandfather of George Washington, who was bom eleven years later. John Fothergill the elder had a tall, well- shaped frame and a powerful voice ; he was a man of authority, upright, inflexible, severe, even to a " faithful son." His ministry was deep and searching, rebuking

inheritance. John Fothergill, J.P., of Brownber, High Sheriff of Westmorland in 191 1, Dr. E. Rowland Fothergill of Brighton, Dr. Claud F. Fothergill of London, and Gerald Fothergill, one of the founders of the Society of Genea- logists of London, are among the present representatives of the family.

It JOHN FOTHERGILL OF CARR END 9

hypocrisy and wickedness as with a sharp sword, yet tender-spirited, yearning over his hearers, and labouring to bring them to " an experience of an holy Uving principle operating in their hearts," which would lead them into all truth and virtue.

An able farmer in his own line, John Fothergill was kind to those around him, and of good repute in the North Riding. His spiritual labours did not hinder him from taking some part in public affairs. In 1734 we find him at York in the midst of a hotly contested parlia- mentary election for the county. It was in the days of Walpole's struggle with the " Patriots " over his Excise Bill. Fothergill signed with three others a circular letter to Friends, urging them to come up and use all their interest on Cholmley Turner and Wynne's behalf ; and this, so the letter ran, as " a necessary service to our king and country, which it is our interest and duty to be concerned in." Turner was elected, with Sir Miles Stapylton for a colleague.

John Fothergill was twice married : his first wife, Margaret Hough, came of a substantial Friends' family at Sutton in Cheshire, and bore him eight children : of his sons several died early : John, the future doctor, was the second who survived ; and Samuel, the fourth, became, as we shall see, a yet more noted preacher than his sire. The father was careful to give his sons a more liberal education than he had himself received. His wife is described as a woman of a meek and grave spirit, who prayed much for her children : she died in 1719, when they were all quite young. In 1727 her husband married a second mfe, Elizabeth Buck, and continued to travel laboriously in truth's service when weakness of body might easily have excused him. He Uved to see his son and namesake well established in London, and the latter faithfully fulfilled a son's duty in caring for his father's declining years. " I have no dependence on human assistance but from thee," wrote the old man in his last letter, " nor any correspondence which affords me like comfort and satisfaction." He

10 FOTHERGILL'S BIRTH AND TRAINING chap.

died in 1744, loved and honoured by his children, and his example was a strong influence in their lives. Dr. Fothergill compiled an Account of his father's Life and Travels, which was pubHshed in 1753 : it consisted chiefly of his American journals. Twenty-five years later the doctor and his sister paid a visit to their father's burial place at Scotton, near Knaresborough. " We rejoiced," writes the former, " in the remembrance of his life : if we wept, it was not from sorrow." ^

The care and education of the future doctor devolved much upon his uncle, Thomas Hough, by whose means he was sent first to a day-school at Frodsham, and afterwards at the age of twelve years to the old Grammar School at Sedbergh, then under the long and tranquil rule of Dr. Samuel Saunders. Fothergill and his brother Samuel lived in a family at Brigflatts whilst attending the school. Here he was well grounded in letters, acquiring facility in the Latin tongue and some knowledge of Greek.^

Thence at the age of sixteen he went to Bradford in Yorkshire to be apprenticed to an eminent Friend apothe- cary, Benjamin Bartlett. The indenture, dated 1728, states that John Fothergill, junior, hath of his own will

^ On John Fothergill, see Account of J. Fothergill, p. 113, etc. ; Mem. S. Fothergill, MS. Letters, Friends' Reference Library, London (Portf. 36, 43, and others) ; Collection of Testimonies concerning Quakers, London, 1760, p. 180 ; J. Gough, Hist, of the Quakers, iv. 326 ; Dr. S. Weir Mitchell, The Youth of Washington, p. 20 ; Diary of John Smith, 1736, in A. C. Myers' Hannah Logan's Courtship, p. 336 ; Tuke, op. cit.

Two of Dr. Fothergill's brothers left descendants. Alexander Fothergill, the elder of the two, lived on at Carr End. One of the latter's grandsons, Samuel Fothergill, bom 1780, became M.D. of Glasgow in 1802, with a thesis De Phantasmatis in Mgrotos potentia. He settled in Leicester Square, London, where he was physician to the Western Dispensary, and co-editor of the Medical and Physical Journal from 1810 to 1821. His work on Tic Douloureux will be mentioned later. Owing to pulmonary weakness he went abroad, and died in Jamaica in 1822 : his widow lived to 1878. See Munk, Roll Roy. Coll. Phys. and the Catal. Surg. Gen. Lib. Charles Fothergill of Toronto, a natvuralist and literary man (b. 1780, d. 1841), was a brother of Dr. S. Fothergill.

Another grandson, John Fothergill, was a surgeon at Darlington, and the ancestor of several Fothergills in the medical and dental professions, including Dr. William Edward Fothergill of Manchester. See also p. 17 note. An account of the descendants of Alexander Fothergill is contained in The Thistlethwaite Family, by Bernard Thistlethwaite, 1910. The offspring of Dr. John Fothergill's brother Joseph will be spoken of in a later chapter.

* Sedbergh School Register, 1909, pp. 163, 164. G. Harrison, Mem. W. Cookworthy, p. 134.

II APPRENTICED AT BRADFORD il

bound himself as apprentice for seven years ; and that he " his master well and faithfully shall serve ; his secrets shall keep ; taverns he shall not haunt ; at dice, cards, tables, bowls or any other unlawful games he shall not play." B. Bartlett covenants to teach him " the art, trade, mystery or occupation of an apothecary," and to give him " sufficient and enough of meat, drink, washing and lodging." The father is to find " all apparels and other necessaries whatsoever," and the consideration money of £50.^ The young dalesman here showed tokens of his future character, attracting admiration by his sensible conduct and aptness, and profiting by the example of a master who was alike gentlemanly and generous.^

After six of the seven years of his apprenticeship had been spent in compounding medicines and visiting patients, young Fothergill, now at the age of twenty years, took the momentous step of entering for study at the University of Edinburgh. This was in 1734. He aimed to be an apothecary, and sought the fuller training to be found at a university. To him, as a Dissenter, the universities of his own country were, of course, closed ; nor was the medical training there given adapted to his needs. Many of the abler medical students went to study abroad, and took a degree at Paris or at Padua, or especially at Leyden, which was then at the height of its fame under the celebrated Boerhaave.

^ The deed is preserved at Ackworth School, together with Fothergill's diplomas from Edinburgh University and from the Royal Colleges of Physicians in London and Edinburgh.

* Successful and valued in his profession, Benjamin Bartlett was also a Friend of grave and solid deportment, zealous for the good order of the church. He took part in the ministry for forty years, offering short homilies on practical religion. He was a lover of hospitality and of good men, and Fothergill kept up his friendship with him until his death in 1759 at the age of eighty-one years. See MS. Testimonies, ii. 47, Frds. Ref. Lib. Bartlett's son and namesake came to London, where Fothergill introduced him to an apothecary's practice in Red Lion Street : this, when his health declined, he resigned to J. Bogle-French, of whom we shall hear again. Bartlett the younger was a man of different temperament from his father ; an antiquary, learned in ecclesiastical coins and the history of parishes, on which he published works. He was a frequent visitor at Fothergill's house. He died at Hertford in 1787. See MS. Journal of Betty Fothergill ; Nichols, Literary Anecdotes, ix. 97 ; B. Bartlett's published works ; W. Scruton, Pen and Pencil Pictures of Old Bradford, pp. 210 fif. ; W. Cudworth, Histories of Bolton and Bowling, pp. 58 ff. ; Ext. from Corresp. R. Richardson, M.D., p. 192.

12 FOTHERGILL'S BIRTH AND TRAINING cha?.

His grandfather Hough had left him £120 towards the cost of his education. Receiving ;^20 of this sum, Fother- gill mounted his horse and set off for the northern capital. His journey from Yorkshire occupied three days ; be spent 17s. 6d. on the road, and sold his horse at the end for four guineas. In Edinburgh he paid half a crown a week for his lodgings.^

We may pause here to recall the Edinburgh of those days, its famous university and the rise of its medical school.

The Edinburgh of 1734 was Httle Uke the Scottish capital of to-day. The castle, indeed, upon its rocky height, Salisbury Crags, and Arthur's Seat, and the sombre halls of Holyrood were then as now, but there were no spacious streets and monuments ; the old town, with its narrow " gates " between tall houses, its wynds and closes, formed the Edinburgh in which Fothergill pursued his studies. The Porteous Riot, which took place during his stay, showed how much of savagery still lingered in the Scottish character. None of the medical buildings of that time seem to be now standing. The Infirmary had lately been opened in a small house near the old university. Edinburgh University dates from 1583, but the medical school came long after, and was young in years when Fothergill entered it. Its history presents a succession of great figures. The first of these is that of the elder Pitcairne, a man of vast acquirements. He was trained in law and mathematics before he touched medicine ; a poet, a brilliant writer, a man of masterfulness and mockery ; a free-thinker in the most religious of capitals. ^ Pitcairne came back

* He was careful of his small means : iis. per lb. was paid for tea, is. 6d. for sugar, and 3d. for butter : gloves cost is. 3d., shoes 4s. 6d., and a hat 7s. 6d. These details are quoted by J. H. Tuke from a little accoimt book, since deposited at Ackworth School.

* " Ecce Mathematicum, vatem, medicimique, sophumque, Pitcairnum magnum haec urnula parva tenet."

Epitaph on Dr. Archibald Pitcaime's tomb in Greyfriars* Churchyard, Edinburgh. Pitcairne (b. 1652, d. 1713) belonged to a Fifeshire family, which yielded at a later date the two Pitcairns, imcle and nephew, who adorned the

n THE EDINBURGH MEDICAL SCHOOL 13

from Leyden in 1693 fired with the ambition to set up a school in Edinburgh that should rival that of the Dutch university. He saw that such a school must be founded upon the study of anatomy, and he put forward Menteith and others year after year in attempts to induce the town to give the needed facilities. But all his efforts were in vain. It was not until the Monros came on the scene that anything was done. Alexander Monro was the first of the three teachers of that name, who between them held the chair of anatomy at Edinburgh in continuity for the long period of 126 years. He was trained by his father from his youth to take this place, and had every advantage which money or influence could obtain. He learned anatomy of Cheselden and Douglas in London ; at Leyden he studied under Albinus, and was a favourite pupil of Boerhaave. His father's efforts collected fifty- seven students to hear his first course of lectures, which he delivered in the old Surgeons' Hall in 1720, when he was but twenty-two years of age ; he made his mark as a teacher at the very outset, and he taught an ever- increasing class for thirty-eight years. " He had to do a new thing in Edinburgh, to teach anatomy and to provide for the study of it in a half-civilised and politically- disturbed country ; he had to gather in students, to persuade others to join with him in teaching, and to get an infirmary built. All this he did " ; and thus " this great and good man earned the title of father of the Edinburgh Medical School." ^

When Fothergill came to Edinburgh in 1734 the school had been organised for scarcely ten years. Around Monro had been gathered five members of the College of Physicians — Rutherford, Alston, Sinclair, Plummer, and Innes. All these had been, like Monro, pupils of Boer- haave, so that the school owed its parentage to the alma

staff of St. Bartholomew's Hospital, as well as that young midshipman, by the irony of fate the most famous of the four, whose name was given to Pitcairn's Island.

^ Struthers, Historical Sketch of the Edinburgh Anatomical School, p. 26. See also Dr. Norman Moore's Fitzpatrick Lectures, 1906 ; and Dalziel, History of the University of Edinburgh.

14 FOTHERGILL'S BIRTH AND TRAINING chap.

mater of Leyden ; Boerhaave was " the master " in their discourses. Some of them lectured in Latin and some in Enghsh.^

Fothergill has celebrated the virtues of his teachers in his essay on the character of Dr. Alexander Russell, his fellow-student. He tells of Sinclair, who lectured on the Theory of Physic ; of his noble simplicity of manners, the elegance and precision of his discourse, and the modesty of his opinions. John Rutherford, professor (with the learned Innes) of the practice of Medicine, lived to an old age to enjoy the praise and esteem of his pupils. He was the father of Dr. Daniel Rutherford, and Sir Walter Scott was his grandson. Chemistry was allotted to the gentle Plummer, a man of universal knowledge, so that, says Fothergill, " the great Maclaurin always appealed to him, as to a living library." Alston presided over Botany and Materia Medica, the learned and inde- fatigable Alston, whose enthusiasm in his subject probably had much to do with his young pupil's life-long devotion to those sciences. " What care " the lecturer showed " to separate truth from falsehood ! How cautious in advancing speculation ! How laborious in experiment, and chaste in forming his conclusions ! "

But Monro was the acknowledged leader of this gifted band ; and it was his fame as a teacher of anatomy that drew men together from all parts of the three kingdoms, and even from the plantations, as the colonies were then called. He won, says Fothergill, " the grateful regard of those who studied under him," by " his singular attention to instruct and encourage his pupils, as well as to act the part of a parent to every stranger."

Fothergill's own abilities were not unmarked by his teacher, and it was by Monro's encouragement that he came to alter his aim in hfe, and to seek the status of a physician, remaining at Edinburgh long enough to take his degree.^ He was a most dihgent student. It was his

^ Manuscript notes of the Lectures of Monro, Rutherford, and Alston are in the Library of the Medical Society of London.

2 According to Lettsom, Monro availed of Fothergill's assistance in pre- paring the fourth edition of his work on the Bones, published in 1746.

r

n ALEXANDER MONRO 15

practice to write out in Latin the notes he had taken of the lectures, then to refer to his medical books, ancient and modern, and finally to set down his own remarks on the subject. He also kept at this time a Latin diary, and the following entry aptly sums up a social visit to one of the professors, who had occupied the evening by talking of his adventures as a student : multa dixit, non multa didicimus (much he said, not much we learned).

A small medical society was formed amongst the students in the year 1734, and carried on with much activity. Fothergill joined it in its second year, and amongst his fellow-members there were several who became his intimate and life-long friends, especially William Cuming, George Cleghorn, and Alexander Russell. Of these, and of the society (now the Royal Medical Society of Edinburgh), we shall hear more later.

Fothergill took his degree in 1736, with an inaugural thesis, De Emeticorum Usu, an elaborate treatise, garnished with numerous quotations, alike from Hippocrates and Celsus, from Sydenham and Boerhaave. These were the early days of the school, and it was but a picked few of the students that obtained the medical degree. Of the four friends Fothergill was the only one to be capped at the close of their studies.

After taking his degree, Fothergill came to London ; the journey by sea then took from six to nine days, and cost I to 1 1 guineas. On arrival he entered himself at St. Thomas's Hospital for a course of medical practice under Dr., afterwards Sir Edward Wilmot, son-in-law to Dr. Mead. This seems to have occupied him for about two years. In his quiet lodging, although he soon came to know many of the Friends, he had much time for solitary thought. His father wrote words of caution and solicitude as to the temptations of the town, but Fother- gill, whose " sweet innocent carriage and deportment " is noted at this time, had a soberness and wisdom un- usual at his years. ^ He was weighing the purpose of life,

1 Fothergill lodged at Robert Bell's in Gracechurch Street in 9th month 1738. His father sends by him his kind respects to the " Syrian Prince "

i6 FOTHERGILL'S BIRTH AND TRAINING chap.

not without rigorous self-examination, and viewing the possible courses that lay before him, and in these and in all that he did he sought for Divine guidance.

Meanwhile a few patients came to him ; he bought books on botany, chemistry, and travel, and carried on studies in the materia medica and in minerals and salts. He kept up correspondence with his old teachers in Edinburgh, and with his college friends ; he wrote also often to his family.

When his two years' hospital training in London was over, Fothergill had to decide where to* establish himself as a physician. He was a very loyal Friend and favour- ably known in the society, then a large and prosperous community in the metropoHs, and including already some medical members. He had drawings to the American colonies, where his father had laboured, and where he already had ties of friendship. His constitution was not at this time robust, and he did not himself look forward to a long course of life. In the end he concluded to remain in the city of London.

Fothergill had long wished to pay a visit to the con- tinent of Europe, such as was customary as part of the training of a physician. The death of Boerhaave in 1738 had damped his zeal for studying at Leyden, but in the summer of 1740 an opportunity came to him for making a tour in company with some Friends. They visited Brabant and the Low Countries, including Liege, cele- brated for its long siege. Spa, and Aix-la-Chapelle, where he observed the mineral waters, " and made some experi- ments upon them — common ones indeed, for want of suitable apparatus." They also travelled to Leyden, where he met Gronovius, and to Amsterdam, and on the Zuyder Zee, and later passed through part of Northern Germany to Bremen, where Fothergill was much interested in the cave under the cathedral with its dry mummified human bodies. During the journey they came into some

visiting London, who, with his men, was to be heard of at " George Thompson's, at the Quakers' Meeting House in the Savoy." MS. Letter in the hands of Miss Fothergill of Darlington ; see also J. H. Tuke, pp. 12, 13.

II VISIT TO THE CONTINENT 17

contact with a new religious movement in Germany, that of the (Moravian) Brethren, but Fothergill was dis- appointed in its professors ; their imaginations had been beforehand, he thought, and gone beyond what they knew from experience ; moreover, they were too full of compliments to one another for the taste of the young Quaker.^

1 See part of Fothergill's letter in elegant Latin to W. Cuming, 1740, in The Works of John Fothergill, M.D., by J. C. Lettsom, iii. p. xvi ; MS. Letter to I. Pemberton, 28. i. 1741, Coll. Phys. Phila. ; Mem. S. Fothergill, p. 82.

Emma Fothergill (sister of Dr. W. E. Fothergill, p. 10 note) married Elbert S. Clarke : these, with their son John Fothergill Clarke (died 1917) have done much pioneer missionary work among the Bantu nations of southern Africa.

CHAPTER III

OUTLINE OF FOTHERGILL'S LIFE IN LONDON

Have I done worthy work ? Be love's the praise !

The world is used to have its business done

On other grounds, find great effects produced

For power's sake, fame's sake, motives in men's mouth

So, good ; but let my low ground shame their high !

Truth is the strong thing. Let man's Ufe be true !

And love's the truth of mine. Time prove the rest !

R. Browning.

On his return to London in the year 1740 Fothergill took a house, No. 2 White Hart Court, which was situated in the northern angle between Lombard Street and Grace- church Street. Here stood in those days a famous meeting-house of the Friends, and around it houses of merchants and others belonging to the society ; in one of them, that of Henry Gouldney, George Fox died in 1691. Fothergill paid in 1748 a rent of £45 for his dwelling-house.^ The place has now long been covered by tall city offices.

Fothergill had now entered on the career of a London physician. An outline will here be given of the chief events in his busy life. Most of these will be again referred to in later chapters, where his medical activities, his friendships, and his scientific interests will be spoken of in more detail, as well as his influence in his own Society and his relations with the American provinces.

It was not long before business came to the young physician, though the returns were small for some years. He received 105 guineas in fees in the year 1740, and expended ;£i04, including £44 for the tour abroad. Whilst

1 W. Beck, London Friends' Meetings, 1869, p. 146. 18

CHAP. Ill HE SETS UP AS A PHYSICIAN 19

at St. Thomas's Hospital his kindness to the patients had won him their regard, and the poor now sought him out, bringing him, not indeed money, but experience and some repute. He was very considerate of their needs, and often traversed long distances in the outskirts of London to visit them, taking no fee. This kindness to the poor he continued throughout his life, even when overpressed with the claims of other patients. He reaped a full reward — more than that which has been attributed to him in the saying : "I climbed on the backs of the poor to the pockets of the rich."

It was customary then for the apothecaries who attended cases of sickness frequently to call in a physician, and when the patient could afford the fees the physician would continue to visit daily or at intervals, meeting the apothecary on each occasion. Such visits formed probably the main part of Dr. Fothergill's practice, besides chamber work at his own house. He obtained the licence of the Royal College of Physicians of London in 1744, and ten years later was elected, at the instance of Dr. John Rutherford, then President of the College of Physicians of Edinburgh, to be an honorary Fellow of that body. It may have been his preoccupations in other ways or the shyness of the young Quaker which hindered him at first from applying for public appointments ; later on his private practice was too large to admit of it. What- ever the cause he seems to have held no appointments of importance.

Fothergill's character was one that commanded the confidence of his own brethren. He soon took his place in the councils of the Friends in London, and had an increasing share in guiding their affairs and interests, both British and American.

He had been but a few years in practice when the chief medical opportunity of his life came to him. Epidemics of throat disorder were then not uncommon. What seems to have been a malignant form of scarlatina swept over London in the autumns of 1747 and 1748, and carried off large numbers of persons, especially children, including

20 OUTLINE OF FOTHERGILL'S LIFE chap.

members of the highest families. Fothergill made a careful study of the disease and was very successful in its treatment. He found the usual methods of bleeding and purging to be generally harmful, and he laid down instead of these a cordial and supporting regimen with especial use of cinchona bark. He published in 1748 ' ' An Account of the Sore-throat attended with Ulcers," The book was much read and many editions were called for. He stepped at once into fame and increased practice. His skill had become known and valued, he had many consultations in the country around London, and his advice was sought in writing by practitioners in more distant parts, in the British colonies, and other countries.

Thus was Fothergill at thirty-six years of age estab- lished in one of the largest physician's practices in the capital. More than thirty years found him still " labour- ing at the oar." Few men ever lived a busier life. Sixteen or seventeen hours of toil were no uncommon event. " I have not slept these twenty hours," he writes to Dr. Falconer, " and have been in action most of the time." Again, in 1768 : "I have not had a moment's respite from intense thought the whole day, but while I get a little abstracted in passing through a crowd from place to place." His sister writes of " the perpetual clamour of people wanting him," and that he was " every night exhausted to the last grain of ability of body and mind." Yet " he seems calm," she says, " and not discontent in the busy scene," though it is " much hke the continual hurry of a whirlwind."

An attempt -will be made on a later page to state the causes of Fothergill's extraordinary success as a physician. It will be sufficient here to allude to his thorough medical training, his reliance on observation rather than on tradition, and to his emphasis upon diet as a means of cure. His quickness of thought, methodical habits, and constant kindness had also much influence. Fothergill's income was now large ; it has, however, probably been exaggerated, and did not really exceed £5000, except in some special years when influenza was prevalent. His

I I

in HIS BUSY PRACTICE 21

aim in practice was never that of money-getting. Beyond the duty of earning his Hving, soon in his case fulfilled, his motive was to give help to others. He declined many fees, and, where need seemed to exist, would often offer a gift of his own to meet the cost of medicines or on some other plea which his delicacy suggested. Such secret benevolence became a habit with him, and no one ever knew its extent. Always on the watch for those who needed a helping hand, he gave and he lent largely, and though sometimes deceived, he was not dis- couraged.

Fothergill never married. He had some drawings to one and another of the young Friends of his circle, but his own standard was so high that he was apt to be disappointed in them ; his habitual caution and self- restraint hindered, too, the expression of his feelings. And so it came to pass that the home was a solitary one, save for social intercourse, until his sister, Ann Fothergill, came in 1754 to live with him. She was a plain Friend from the Yorkshire dales, brought up in a narrow circle, and aware of her own deficiencies, but she adapted herself to the place she had to fill in Fothergill's house. Her native shrewdness, good sense, and kindly spirit enabled her to dispense the large hospitalities which her brother loved with wisdom if not with grace, and she won his confidence and gratitude. Most often they had visitors to breakfast, and frequent callers in the day, whose entertainment fell chiefly to her lot. Young men, and those who needed notice and help were especially welcomed, and Fothergill's counsel was sought by many, and on many topics, for he had the faculty of judgment in an eminent degree — disinterested, cool, and often swift. His popularity as a physician, even among the upper ranks of society, was won and kept without any abatement of the ways of the Quaker, for the strict garb, singular language, and unlifted hat were made acceptable by a gentle and tactful manner. He had many friends, and the bond of friendship was to him deep and real. He kept up a correspondence with the comrades of his

22 OUTLINE OF FOTHERGILL'S LIFE chap.

student days, and when Cleghorn came home from Minorca in 1750, and Russell from Aleppo in 1755, he welcomed them, gave them his aid and advice, and in each case induced them to publish the results of their observations. Dr. Cuming of Dorchester, another fellow- student, a man of lovable character, was an intimate correspondent for nearly fifty years.

His chief friend outside the medical profession was David Barclay, a Quaker merchant of London, who had married a young patient of Fothergill's. Barclay was a man of a certain type of nobility, physical and mental — philanthropic, even-tempered, and sincere. Fothergill and he worked much together in later years.

As he grew into middle life, Fothergill's scientific tastes found more and more employment. He wrote to his friends in America for rattlesnakes, tortoises, and new plants, and compiled papers for the Royal Society on the origin of Amber and on Manna. He got sea-captains to bring him strange things from China, from Borneo, from Hindustan. He collected corals, shells, and insects, and in course of time his cabinets became famous among the learned. But beyond all these it was the pursuit of botany that especially attracted him. Here his friend Peter Collinson was the means of fostering Fothergill's taste. Collinson, a Quaker like himself, was a naturalist of keen instincts, and he and his American friend, John Bartram, were the means of enriching English gardens with many new trees and shrubs. Following his example, Fothergill planted a large botanical garden at Upton in 1762, upon which he bestowed much care and expense. His collectors searched for new plants in many lands, and his garden and hothouses were stocked with thousands of species of hardy and exotic plants. Fothergill was a great collector ; but mere rarity had little attraction for him ; he sought for products that would be useful as food, as medicine, or in the arts, or that were of beauty in themselves. He became a Fellow of the Society of Antiquaries in 1753, and ten years later, at the invitation of some members of the Royal Society, he offered himself

»

III HIS COUNTRY HOUSE 23

and was elected as a Fellow of that body.^ He was chosen a member of the American Philosophical Society in 1770.

FothergilFs labours in London became so continuous that he felt the need of some yearly respite. Travelling was then slow and arduous ; people but seldom left their homes except to visit their relations, or in search of health at one of the spas. Few facilities existed for a trip abroad, or even to different parts of the kingdom. The rich would rent a house in the country, and retreat thither occasionally, journeying in their own carriages, and staying at the numerous inns on the road. Such a plan came into Fothergill's mind. His aim was quiet ; therefore he sought a place too far away from London to be followed, where he had no acquaintance, where the roads were not good, and there was nothing to attract the " curious idler." It must be in a healthy country situation, where he could ride out daily on horseback, and near to a Friends' Meeting, and to a market-town.

He was attracted to Cheshire, his mother's county, and to the neighbourhood of Warrington, the residence of two of his brothers. After some search he heard of a country house. Lea Hall, in this district, four miles distant from the modern railway town of Crewe. He took the place, and spared no pains or expense to make the mansion and grounds comfortable and pleasant.

To Lea Hall Fothergill retired for about two months each autumn from the year 1765 to 1780, the year of his death. But he was not idle in this secluded spot. " Hither I bring down," he told a friend, " a great cargo of letters " ; and many more soon followed him. His correspondents were in most parts of the civilised world. It was here that much of his writing work was done in botany, in philanthropy, and in politics, and especially in the concerns of his own Society. Here, too, he com-

^ The nomination form recommends him for his extensive learning and abilities, his " application of many years to the improvement of Natural History," and "his constant readiness to promote every other branch of science." It is signed by A. Russell, P. CoUinson, Gowin Knight, (Sir) John Pringle, John Ellis, C. Morton, etc.

24 OUTLINE OF FOTHERGILL'S LIFE chap.

posed many of his medical papers. He discouraged practice, and made it a rule to take no fees whilst he was away, leaving his wealthy patients to the care of others. But he devoted one day in each week to give his advice gratis to the poor, attending for the purpose at the old royal borough town of Middlewich, a few miles away, where he sat to prescribe for patients — it is said, at the White Bear Inn. Such indeed was his reputation that, on his four or five days' journey to and from his country seat, his coach was often beset by apothecaries and importunate persons seeking his advice. He was obliged at some places on the route to sit at a table with an amanuensis and deal with a crowd of poor sick people.

Lea Hall, a roomy brick mansion of Queen Anne's date, was at one time occupied by the Lowndes family. It was surrounded by a moat, and stood in well-stocked grounds, amidst plantations, orchard, and fruit garden. From the roof a wide extent of country was visible. The house has undergone changes in later times : the fine oak panelling of the lofty rooms has been painted over, but a noble staircase remains. Secret panels in some of the chambers formerly opened into hiding-places; one of the tall chimneys contained such a cachette. Much of the moat has been filled, and the orchard is gone ; the garden, too, which Fothergill planted with duplicates from Upton is no longer kept up : rare species supposed to have escaped from his cultivation were at one time found in the neighbourhood.^

It was then unusual for physicians to take long hoH- days, and some who had attempted it found their practice much diminished on their return. But in Fothergill's case it was not so ; he came back to town and was at once busy.

In 1767 he moved out of the city to Harpur Street,

^ Lea Hall was at a later date in the possession of Sir J. Verdin, Bart., and now belongs to the United Alkali Company. The author is indebted to the kindness of Mrs. E. B. Harlock and to Mr. C. F. LavsTence, both of Middle- wich, for information. See also Works, iii. p. Ivii ; Mem. S. Fothergill, pp. 453 ff. ; Tuke, pp. 34-37 ; Letter, J. F. to J. Pemberton, 16. 9. 1768, Etting MSS.

I

III HIS MEDICAL FRIENDS 25

Bloomsbury, then a place of elegant resort. A notice of this house will be given in another chapter.

Amongst those who frequented his home at this period, and to whom Fothergill gave counsel and help, were three young doctors, trained at Edinburgh — Lettsom, Gilbert Thompson, and Anthony Fothergill — a fuller notice of whose careers is reserved to a later page. Thompson's tastes were somewhat literary and academic ; his work as a physician was hindered by a natural diffi- dence. Anthony Fothergill, only distantly connected with his namesake, was scientific, and had afterwards considerable repute as a physician at Bath. Lettsom entered on practice in the city of London under the aegis of Fothergill, soon after the latter had moved to the west. He had a ready flow of conversation, and an equally facile pen ; was genial, generous, and humane ; and enjoyed for many years the fame of a popular physician and philanthropist. Lettsom founded in 1773 the Medical Society of London, one of the earliest of those associations which have done so much to promote general medicine.

Fothergill himself had to do, as we shall .see later, with two small societies, more private in their character. One, the Medical Society (of Physicians), held a very useful place from about 1752 onwards, receiving and publishing essays on medical topics derived from both home and foreign sources. Fothergill contributed many of these papers, which were chiefly clinical descriptions of disorders hitherto ill-recognised ; those on angina pectoris, sick headache, and tic douloureux are among the best known. The second society was the Society of (Licentiate) Physicians, originally formed in 1767 to defend the interests of the Licentiates, but papers were afterwards read before it.

His medical reputation was now universally acknow- ledged. In 1774 he was proposed by Lord North to the king for appointment as one of the royal physicians. The king replied, " I doubt whether a Quaker can hold an office, but if he can I have no objection to appointing

26 OUTLINE OF FOTHERGILL'S LIFE chap.

Doctor Fothergill ; I therefore desire you will find whether the thing is practicable." ^ Probably the oath stood in the way, or it may be that Fothergill's modesty declined the honour. When the Societe Royale de Medecine was formed at Paris in 1776, Fothergill was elected a Foreign Associate, a distinction conveyed in a cordial letter from Vicq d'Az)^:.^

In 1768, at the request of the Russian Embassy in London, Fothergill recommended his friend Dr. Thomas Dimsdale to go to St. Petersburg to inoculate the Empress Catherine and her son for the small-pox. Dims- dale carried out this mission with conspicuous success, and came home a baron of the Empire, loaded with riches and other rewards. A narrative of his visit, published for the first time from private letters, is given in another chapter.

His jealousy for the honour of his profession was the means of leading Fothergill into a dispute with a fellow- quaker. Dr. Leeds, which brought much trouble to his sensitive mind during the years 1771 and 1772. This will be noticed later.

The influence and repute of Fothergill enabled him to pursue his philanthropic aims with ever fuller effect. He aided John Howard in the reform of prisons. With his friend John Hustler he promoted the making of canals ; and he thought and wrote much on measures to ensure the cheapness of food. Many papers from his " pen were published in the journals on the better govern- ment of the metropolis, advocating reforms, some of which he lived to see adopted.

One of the chief motives of Fothergill's life was the increase of knowledge. Truth was dear to him in every form, and he had much confidence in the spread of know- ledge as a factor in human progress. He set a high value upon literature as a means to this end, and made many presents of books to libraries. Although in his busy life he wrote no considerable works, he had a silent part in

^ Corresp. of Geo. III. with Lord North, i. 202. * The original is in the possession of the family. Works, iii. p. cxxxviii.

ra ANTHONY PURVER'S BIBLE 27

the issue of not a few books of scientific, topographical, or religious character. He initiated some of these, he gave his counsel to their authors, he revised the proofs, and in several instances he supplied a part or the whole of the expense. Amongst the works thus aided may be counted the large volume of Illustrations of the Sexual System of LinncBus, by John Mueller, drawn chiefly from the originals in Fothergill's garden; Edwards' Birds of Great Britain, and Drury's Entomology. Other volumes, connected with his own Society, included the writings of William Penn, and the Baskerville edition of Barclay's Apology. He was most unwilling to have books dedicated to himself, but all his efforts could not always prevent it. Fothergill's part in the issue of Purver's Bible must have a fuller notice. Anthony Purver was a poor school- rhaster of Andover, who had spent thirty years in making a new translation of the Bible, but could not get it pub- lished. Fothergill examined the work and approved it, paid the author £1000 for the copyright, and had it printed at his own expense, revising the sheets himself. Purver was a man of uncommon memory and great industry, rising at four o'clock daily, and devoting his days to study. He taught himself Greek, Hebrew, and several other languages, and read his sources well, in- cluding Rabbinical and classical writers. A blameless man and a lover of truth, his manners were simple and his spirit reverent. In his translation he tried to keep close to the text, but to give the sense in plain modem speech, pleading that the Scriptures needed fresh render- ing from time to time in the growing living language of men. This was somewhat daring doctrine, since the recognised versions were accounted almost sacred, and Purver, who had joined the Friends, had no church or collegiate standing. Following his own principle he discarded many old-fashioned words, such as ye, yea and nay, verily, twain, bondman, apparelled, etc., giving instead their modern equivalents. It is curious to note that our Revisers of 1884, coming more than a century later, have nevertheless retained these older forms. In

28 OUTLINE OF FOTHERGILL'S LIFE chap.

a good many of his improved renderings, however, he anticipated the Revisers ; and he even mixed his tenses in a literal following of the Greek text as they have done. In the Gospel of John he translated " Son of Man " by " The Man." But Purver's lack of literary training rendered his style uncouth ; so that his sentences ran uneasily, with little euphony or poetic rhythm. It was, however, a courageous and laborious attempt to frame a truer version in the language of the day, and it may have suggested many renderings to later translators. The work was well printed in two large folio volumes in 1764. Fothergill exerted himself to circulate it, giving copies to many of his friends on both sides of the Atlantic.^

Another work issued under Fothergill's auspices, and with a Preface from his hand, consisted of some letters on Electricity by an ingenious printer of Philadelphia, after- wards famous as Dr. Benjamin Franklin. This was in 1 75 1, and it led to a friendship with Franklin, who when he came to London in 1757 was advised to obtain Fother- gill's counsel in his negotiations with the Proprietaries of Pennsylvania. Franklin remained in London, except- ing for an interval of two years, until 1775, and, as will be more fully related, was on intimate terms with his Quaker physician.

Fothergill was a Whig of decided opinions, and favoured the cause of freedom, having close ties and sympathies with the American colonists. During the last fifteen years of the Quaker domination in Pennsyl- vania, which came to an end in 1756, Fothergill had an important part as one of the leaders in the home church, being also in frequent touch with the government. He was able to look at the cause of the growing provinces as a whole with an understanding eye, and he saw that the

^ " A New and Literal Translation of the Old and New Testaments, with Notes, Critical and Explanatory. By Anthony Purver, Lx)ndon, 1764." Purver was born in 1702, married Rachel Cotterell of Frenchay in 1738, and died in 1777. He addressed " A poem to the Praise of God," to his wife ; it was printed in 1748 ; as well as " Counsel to Friends' Children " in rhyme. See Did. Nat. Biog. ; Friends' Magazine, 1831, ii. 49 ; Tuke, p. 41. Also MS. Accounts of A. Purver, in a Letter from Jacob Bell, 1796, Account [by J. Gumey Bevan], and in Biog. Mem. by E. Backhouse, iv. 469 : all at Frds. Ref. Lib.

in HIS POLITICAL EFFORTS 29

prospects of liberty in Britain itself were bound up with it. During the momentous years which led up to the War of Separation Fothergill watched closely the course of events. His practice took him often amongst those in authority. In the winter of 1774, when things were drifting towards a rupture, the king and government blindly refusing all concession, Fothergill with his friend Barclay made a last effort before FrankUn left England to negotiate a settlement. The triumvirate met again and again at Fothergill's house, and drew up a scheme of conciliation, which obtained some hearing from the ministry, but was wrecked by its extremer members. Most of its provisions were indeed embodied in an act passed after war had broken out, but it was then too late. A full account of this negotiation is given in the present volume, taken from the original documents, which will be found printed in an Appendix.

Besides his political efforts, Fothergill was able to render good service to medical education in America. What he did for the young men who came to England for study, and Tiow he helped the establishment of the Pennsylvania Medical College, the first institution in America to grant degrees in medicine, will be told in another chapter.

We have thus followed in outline the events of Fother- gill's life down to his later years, active as he was in several different fields. In succeeding chapters some of these manifold activities, on his own part and on that of his friends, will be depicted in fuller detail. Finally, some notice will be given of Fothergill's closing years, during which his work for education was consummated by the foundation of Ackworth School.

CHAPTER IV

FOTHERGILL AS A PHYSICIAN — HIS WORK IN THERAPEUTICS

I swear by Apollo the healer and by ^Esculapius, that I will use the regimen in aid of the sick to the best of my power and judgment. I will keep away from all hurt and wrong-doing ; nor will I ever give a deadly drug to anyone who asks me for it ; but with purity and with holiness will I observe my course and foUow my art. Whatsoever I may see or hear in the life of men that ought not to be published abroad I will hold secret. And as I fulfil this oath and break it not, may the full enjoyment of my hfe and art be granted to me, held in honour among all men to the end of time. — Extracts from the " Oath of Hippocrates," fifth century B.C.

If a doctor's life may not be a divine vocation, then no hfe is a vocation, and nothing is divine. — Confessio Medici.

Si les fonctions du medecin sont beUes, c'est moins en effet dans les palais et parmi les grandeurs que dans la demeure etroite et mal saine du pauvre. C'est la ou I'homme peut secourir I'homme, sans concours et meme sans temoins ; c'est la ou Ton est sur de trouver des larmes a essuyer, des infortun^s a plaindre. Disons-le a la louange des mede- cins, quel autre ordre de citoyens remplit ces devoirs augustes avec autant de zele et de courage ? — Vicq d'Azyr, £loge de Fothergill.

The public repute of Fothergill during the latter years of his practice throughout Great Britain and Ireland, in some parts of Europe, and in the North American colonies and the East and West Indies, was probably greater than that of any other London physician. Franklin says that many Quakers crossed the Atlantic on purpose to consult him. His postal address had long been merely " Dr. Fothergill, London."

WTiat were the causes of his extraordinary success in practice ? Let us take some personal qualities first. Fothergill was an admirable man of business, orderly and dispatchful, giving no place to delay. This enabled him to carry through work of wide extent and variety without

30

I

CHAP. IV CAUSES OF FOTHERGILL'S SUCCESS 31

confusion or disquiet. Then he was gifted with a keen intellect and rapid insight. He soon made up his mind, and, it may be added, he was not apt to change it. This tenacity of opinion, which may have been sometimes ill- advised, is explained by his friend Dr. Percival, who says that Fothergill had come to rely on an intuitive dis- crimination of diseases, the result of long experience, and that an authoritative expression of his opinion was a necessity of his busy work.^ So quick indeed was he sometimes as to incur the suspicion of trifling with his patients, but the event showed the wisdom of his counsel. With these qualities was combined a disposition of great kindness, so as to overspread the peculiarity of his address, due to early Quaker training, with a certain engaging sweetness. Severe as his face was, it ever wore a smile for the sick, a " hope-inspiring " smile, which commanded confidence, and called forth new efforts towards recovery.

Although he had constantly to deal with the weak, the wilful, and the wajrward among his many clients, yet his own attitude was so charitable and so wise that he never despised their frailties. He resisted the tempta- tions which beset physicians. The sacred art of healing was to him no mere source of lucre. " My only wish," he said, " was to do what little business might fall to my share as well as possible, and to banish all thoughts of practising physic as a money-getting trade with the same solicitude as I would the suggestions of vice or intemperance." ^ He did not pander to his patients, nor amuse them with dishonest nostrums, far less prey upon the nervous or the confiding. Nor did he want for his reward. " I have not served," he wrote, " an ungenerous or ungrateful public." " To me the world

^ Pettigrew, Memoirs of J. C. Lettsom, with his Correspondence, iii. 394.

^ Letter to Lettsom, 1769. He was thankful, so he wrote, to the gracious Preserver, " that kept my mind more attentive to the discharge of my present anxious care for those I visited, than either to the profits or the credit resulting from it." To be kept in such a temper, he added, working with diligence, humility and as in the sight of the God of healing, frees the mind from unavailing distress and disappointment. To the same, 1773. Works, iii. p. xxv.

32 FOTHERGILL AS A PHYSICIAN chap.

has not frowned ; I courted not its favours nor feared the reverse."

We may turn to a private memoir to learn the impres- sion that he made upon his patients. The doctor's presence, so we are told, " was never waited for above a minute or two beyond the time fixed for his coming. His gentle though firm demeanour calmed sorrow into silence. His penetrating eye and abstracted thought always inspired confidence in his judgment [even] though there might appear not the least prospect of success. To him," the writer continues, " my father spoke of his concerns as to a friend, and of his complaints as to a physician of distinguished skill. On being one day asked whether Dr. Heberden should be called, who was the only senior physician, and consequently the only one who could act with the doctor, he replied, ' No ; my Hfe is in God's hand and Fothergill's.' " She goes on to describe the scene when her father lay dying, how tenderly Fothergill took her mother by the hand, and stroked the daughter's face, as he spoke faltering words of sympathy.^

In the next place, his medical training had been thorough, grounded as it was upon anatomy, and upon full courses of botany and chemistry, with the best clinical teaching that Edinburgh and London could afford. He knew Hippocrates well, and Aretaeus and Celsus, but he was imbued with the spirit of " the great Boerhaave (so he wrote), who did much in the theory of physic, in respect to separating truth from falsehood, certainty from hypothesis " ; Rationalem quidem puio medicinam esse dehere, he would say, et instrui ah evi- dentibus causis.

In estimating Fothergill's position as a therapeutist, we may pause to consider the state of that science in his age. A revolution was in progress during the seventeenth and eighteenth centuries in the use of medicines. In few depart- ments of fife have the rules of tradition maintained a longer and firmer hold than in the heaHng art. Pharmacy in the

1 MS. Memoirs of Barbara Hoyland, by herself. Extracts are quoted in the Journal of Friends' Historical Society, iii. 131.

k

IV THE REFORM OF THERAPEUTICS 33

earlier century was still dominated by formulae which had come down in some cases little changed during a thousand or fifteen hundred years. Confections and electuaries, com- pounded of a multitude of miscellaneous and incongruous substances, were still prescribed as sovereign remedies for the ills of the body. They were often dignified by resounding titles, which had been bestowed by some revered master. Such were the Diacastorius and the Diasatyricon ; the Atha- nasia Magna contained among many other things the liver of a wolf and the horn of a goat or stag ; the Aurea Alexandrina of Nicholas of Alexandria ^ had sixty-nine ingredients, and the long list of diseases it could cure was crowned by the words ah omni ventris malo liberat.

It was from imposture of this kind, grown hoary by age, that Sydenham and Boerhaave and others of the natural school had begun to deliver the medical art, by prescribing a few remedies, chosen rationally, instead of the weird and marvellous compositions of the ancients.

Felix, simplicibus novit qui tollere morhos ; Pro quovis morbo est una vel herba satis.^

But the change took effect slowly : physic was still in some sense a mystery ; and the apothecaries taught their pupils in the old ways. The official organs of the art, the pharma- copoeias, which became systematised in Fothergill's time and ruled its practice, were loth to part with the old forms. It was not until 1788, eight years after Fothergill's death, that the London College of Physicians at last omitted from its Pharmacopoeia the famous Theriaca Andromachi, or Venice treacle, with its sixty-five ingredients, including dried vipers ; and the Mithridatium of Damocras, whose fifty components included the bellies of lizards. Both these relics of poly- pharmacy had come down from before the time of Galen, and it needed all the earnest persuasion of Heberden to effect their omission. For Heberden had shaken himself free of pharmacal fetters ; he told Lettsom once that he cared little for the latter's new manuscript of Hippocrates ; he would rather know, he said, what men would be thinking 2000 years hence than what they believed 2000 years ago.'

The Edinburgh School had followed Boerhaave in his

^ The Sal Sacerdotale of this thirteenth-century physician was alleged to have been used by the priests in the time of Elijah the prophet.

* Zwelfer, Pharm. Regia, 1675, p. 163.

* Mem. Lettsom, iii. 124.

D

34 ^FOTHERGILL AS A PHYSICIAN chap

more rational methods, and Fothergill carried forward the change that was in progress, using his own thought, making experiment, and varying his practice with the result. It is true that he did sometimes prescribe both Venice treacle and Mithridate, but it was with a half apology : " Be the mixture of Conf. Cardiac, [compounded of strong spices, aromatics, crabs' claws, etc.] never so absurd," he writes, " I give it as a simple medicine." His compositions contained a few well-selected drugs, suitably blended; and as his practice extended, his mode of prescribing was imitated by others and largely adopted. Lettsom hazards the assertion that Fothergill principally contributed to bring about the revolution which replaced multifarious and discordant compounds by such as were elegant and compatible. This claim may be too large, but at any rate he was one of the best prescribers of his century in English medicine, and did much to develop the art on reasonable and natural principles. Some of his formulae continued to be used after his time.

Fothergill was at home in the vast armoury of vegetable remedies then in use, for he knew them not only in the forms they present in pharmacy, but in many cases also in their natural state, as herbs and trees. In the early years of his practice, whilst he still had time on his hands, he occupied himself with studies in the Materia Medica ; frequenting the druggists' shops, he explored the crude drugs from which remedies were prepared, and consulted books of travel and sea-captains, even writing to corre- spondents in distant lands to obtain fuller knowledge. By comparing specimens, and subjecting them to experi- ment and analysis at his own house, he was able to establish the true nature and source of some ill-known drugs. He wrote many letters to Professor Alston, his old teacher in Edinburgh, on these topics.^ London at that time possessed few facilities for medical or indeed for any other academic study : the historian must stand

^ MSS. Alston, see Appendix D. Besides the drugs mentioned in the text. Senega, Opobalsamum, Labdanum, and Camphor were particularly noticed.

IV HIS INVESTIGATIONS OF DRUGS 35

amazed that this great and wealthy city possessed no university till the year 1837, ^^^ then one that merely held examinations for degrees. So long the two ancient English universities with their formal courses dominated the field. Fothergill saw the need of medical teaching in London, and he proposed to himself to give lectures on Materia Medica in its relation to general medicine. During several years he made preparations for this purpose, and formed a fine collection to illustrate the subject ; but his time became otherwise filled, so that in the end he abandoned the project, and presented his collection to his old college at Edinburgh.

His investigations of several drugs formed the subject of papers. Thus he brought before the Royal Society in 1744 an account of a specimen of Persian Manna derived from a prickly shrub, and discussed, with the help of references to Greek writers and modem travellers, the origin of the drug ; describing also the method of obtaining it in Italy and Sicily as an exudation from the bark of species of ash-tree.^

In 1756 Fothergill introduced the astringent gum now known as Kino to the medical profession ; it was the dried juice of a tree (Pterocarpus) growing on the river Gambia in Africa. The story of his chance meeting with a specimen, and his search for more, shows how keen was his interest in all remedies that promised to be of use.^ Catechu had been brought from Japan in the previous century, but was errone- ously thought to be an earth, and was known under the name of Terra Japonica. Fothergill showed in 1773, by evidence sent him from Behar in Hindostan, that it was an extract of the wood of a species of acacia. He proposed to send the

^ Observations on the Manna Persicum, Phil. Trans, xliii. 86, with additions in ihG Abridgement ; Works, i. 2^7 ; MSS. Alston. Manna, a mild sweetmeat- like laxative, a favovirite with children, is now disused in England, and was omitted from the British Pharmacopcfiia in 1898. It was still a familiar object on the medicine shelves fifty years ago.

2 A Letter to the Medical Society concerning an Astringent Gum brought from. Africa. Fothergill called it Gummi Rubrum astringens Gambiense. Medical Observations and Inquiries, i. 358 ; Works, ii. 19 ; Cullen, Materia Medica, 1789, ii. 43 ; Fluckiger and Hanbury, Pharmacographia, p. 170. It was at first confused with Dragon's Blood, which is an inert resin from various trees, no longer used in medicine ; and with Gum Senegal, a yellowish-red acacia gum. The name Gummi rubrum was later applied to the red gum obtained from Eucalyptus bark {Kino Eucalypti, B.P. 1914), introduced by Sir Ranald Martin as a powerful astringent.

36 FOTHERGILL AS A PHYSICIAN chap.

plant for cultivation to the West Indian Islands, where he thought it would flourish ; this seems to have been done, for these islands are now the chief source of the drug.^

Winter's Bark is the product of a, beautiful evergreen tree, Drimys Winteri Forst., of the Magnolia order, which grows on the shores of the Straits of Magellan. It was first obtained by Winter, one of Drake's captains, in 1578, and was used by him as a remedy for scurvy. But it was a rare drug : Canella and other barks were generally substituted for it. Fpthergill obtained some of the genuine bark in 1768, with a branch of a tree. Ehret drew it for him ; Solan der described it, and Dr. M. Morris analysed its properties — those of an astringent tonic with an aromatic bitter taste. It is said to be still much used in Brazil in cases of diarrhoea and debility. Fother- gill tried to introduce the tree into England, and offered ;^ioo to the captain who should bring a living plant. It now flourishes in some parts of Ireland.^

Fothergill took some pains to obtain Sassafras, the product of a handsome North American tree, a species of laurel with curious variable leaves, and used it as a warm aromatic diaphoretic. It is an ingredient of the compound decoction of sarsaparilla. He also exerted himself to ensure the proper drying and preparation of Turkey rhubarb, which had been naturalised in England by Dr. John Hope of Edinburgh, with whom he had corresponded for many years. ^ That violent purgative Elaterium, now almost disused, was extracted by a secret process from the squirting cucumber. FothergiU took much pains to search this out, and at length by patient experiment discovered the method of preparing the drug.

In the growing science of chemistry, too, he took a keen interest, and was able to make a more intelligent use of mineral salts and acids in his practice than had been usual.* He sought to apply chemical principles to

'^ An Account of the Tree producing the Terra Japonica, with a good drawing and botanical description. Med. Obs. & Inq. v. 148; Works, ii. 191, iii. p. xlvii ; Fluckiger and Hanbury, p. 240. The drug was classed among Terra Medicamentosa, in the Lond. Pharm. of 1721. See also Letter from A. Keir, Bengal, 1753, in MSS. Alston.

* Some Account of the Cortex Winteranus, etc., read 1773 ; Med. Obs. & Inq. V. 41 ; Works, ii. 163, iii. p. xlvii note ; Fluck. & Hanb. p. 17. Sir F. W. Moore, Keeper of the Royal Botanic Gardens, Glasnevin, kindly informs me that there are plants in these gardens, some of them out of doors, and that the Winter's Bark flowers freely each year in Wicklow as a hardy tree, 30 feet in height.

* Works, iii. pp. 1, Ixi ; Mem. Lettsom, iii. 260.

* One of his earliest papers, contributed to the Edinburgh Medical Essays and Observations in 1736, discusses the methods of obtaining saline substances

IV THE VALUE OF MINERAL WATERS 37

mineral waters, and his letters abound in directions for the use of those of Buxton, Bristol, Tilbury, or Scar- borough. It seems that he was less fond of Bath, although he considered it helpful in two types of gout. One of his early but unfulfilled aims was an examination of all the waters to be found near London, with experiments to demonstrate their nature and kinds. He thought there was a " slight calcareous stypticity " in the Bristol and Buxton waters which was carried into the remotest parts of the system. Here are his directions to a gouty patient at Buxton : "If the pain goes quite off, go into the water without fear. Do not stay long ; be at the expense of a chair to bring thee back to thy lodgings, and get for a quarter of an hour into a warm bed, not to sweat, but to be thoroughly dry." During a short stay at Buxton in 1779, he was able to introduce important improvements at the Spa, especiall}^ in the provision of private baths, and in setting up a few baths capable of being warmed to any temperature required.

Fothergill used Antimony with some confidence. It piay be worth while, apropos of his part in the story, to recall the history of this remedy. In the form of the black sulphide (Stibnite) antimony was well known to the ancients, whose fashionable women, including queen Jezebel, used it for painting their eyelashes ; it was also famous as the basis of colly ria for the eyes. It was not much given internally until near the year 1600 when the Currus Triumphalis Ardimonii of Basil Valentine brought it into note. The author of this mystical and rhapsodical treatise thunders in the hoUest of names against the ignorance of the doctors, proclaims antimony as a remedy for all ills which can happen to the human body, and caUs upon those who aspire to knowledge to peruse lus writings, which will render his name immortal. He shows, how- ever, some chemical acquirements, and describes the methods of preparation of the salts of the metal. A hot controversy arose at this time about antimony, whether, being branded as a poison, it should be given as a remedy, and the literature

from tartar (the crust deposited by wine), and describes the proper preparation of Terra Foliata Tartari or Sal Diureticum (Potassium Acetate), which he found useful as a mild cathartic. This drug attained much repute during his period. Remarks on the Neutral Salts of Plants, etc., Med. Essays, v. 147 ; Works, i. 241 ; Colborne, Eng. Dispensatory, 1753, pp. 137-139 ; MSB. Alston, p 57.

38 FOTHERGILL AS A PHYSICIAN chap.

of the subject was large. The Faculty of Medicine in Paris, no doubt espousing the official Galenist view against the new chemists or alchemists, prohibited in 1566 the use of the metal as a drug ; and graduates of Heidelberg University were required, it is said, to take an oath that they would never prescribe it. It won its way nevertheless in face of all opposi- tion, and in the eighteenth century its preparations were in high esteem and " in copious use." Antimonium Sulphur atum, nearly equivalent to the " Kermes mineral," was a constituent of the weU-known Plummer's pill. " James's powder," long a private nostrum of Dr. R. James (who died in 1776), had a great reputation as a febrifuge and diaphoretic : the Pulvis Antimonii Co. (P.L. 1851, mainly Antimonious oxide) was an imitation of it.

Fothergill used principally the unwashed calx or dia- phoretic antimony, a mixture of antimoniate and antimonite of potash, and a preparation of very uncertain strength : it was in consequence omitted from the later formularies of the century. He prescribed it together with aloes, scammony, and extract of colocynth. This combination was known for generations after as " Fothergill's pill." ^ He treated hooping-cough with tartar emetic, giving gr. yV-| daily in the forenoon to empty the stomach, and a smaller dose at night, with nitre and contrayerva, as a diaphoretic. Under this treatment, with light diet, he claims that the cough became less frequent, and after a time less violent.^ But his

^ Beasley, Druggists' Receipt Book, 1857 ; Christison, Dispensatory, 1848. At other times Fothergill combined the calx of antimony with aloes and myrrh, or aloes alone. Another favourite pill is thus ordered :

R Pil. Rufi [Aloes et Myrrh].

Pil. Ecphract. [A deobstruent pill, containing aloes, aromatics, rhubarb, salt of steel, etc.] aa ^is%.

Sapon. Venet. [Castile soap] Si-

01. Cinnam. gt. vi. m. ft. pil. XXX. capiat ii vel iii omni nocte.

Amongst other prescriptions of his is one for equal parts of magnesia and sulphur, with a few drops of oil of caraway, to be taken nightly in warm milk and water. Vinum chalybeatum he often ordered, in a draught with aromatics or peppermint. See prescriptions printed in Fothergill's Works : others in original MS. at Ackworth School, and in the hands of J. J. Green and the Author. A poultice is to be made of rye-meal i lb., salt 2 oz., and barm 4 oz., kneaded with warm water. Weak eyes are to be steamed with an infusion of rosemary and lavender flowers. Enterprising druggists long traded on his reputation.

* A Letter relative to the Cure of the Chin-Cough, to the Medical Society in London, read 1767 ; Med. Ohs. & Inq. iii. 319 ; Works, ii. 43. Dr. M. Morris in a paper read at the previous meeting advocated castor and the bark. Excepting country air no remedy of proved efficacy was known : " respiring

£v HISTORY OF THE USE OF ANTIMONY 39

chief use for antimony was in chronic distempers, perhaps especially in plethoric conditions, where it quieted the circu- lation, and acted too as an eUminant. This mode of action came under the term " alterative," and as such continued to inspire faith in the medical mind until far on in the next century.

In the meantime Rasori (1799), Louis and the French School had brought antimony into use in the treatment of inflamma- tions. Blood-letting had begun to lose its hold, and this depressant drug took in a great degree its place, and gave better results. In the earher half of the nineteenth century, the treatment of pneumonia and of cerebral and other sthenic inflammation by means of tartar emetic held full sway among the best practitioners. Many believed that it cut short these diseases : Sir T. Watson thought it very valuable ; according to Graves it might save life. The remedy had a strange attraction for some minds. Dr. Archibald BilUng (physician to the London Hospital from 1822 to 1845) was an enthusiastic behever in antimony : it was a " heal all " in his practice. Trousseau explained its use in pneumonia by its toxic action on the heart, diminishing the quantity of blood sent to the lungs, and so giving relative repose to those organs. But medical opinion at length turned. Thus T. K. Chambers' experience (1863) led him to dwell on the risks of antimony : it lowered the vitahty of the patient ; and was, he said, a poison in pneumonia. Its use in such disorders is nearly extinct to-day, and for the most part antimony is now neglected, save for its occasional employment, in the form of the wine, in some inflammatory skin diseases, and in the respiratory catarrhs of children ; as well as in veterinary practice.

From this disuse the drug may probably again be rescued, for Professor Cushny showed in 1907 that it has the property in common with arsenic, but more efiiciently, of destroying the trypanosome of sleeping sickness, even when the remedy is much diluted. This observation is important, since this protozoal organism has much likeness to the spirochoete of syphilis. In 1913 Tsuzuki of Japan recorded a series of successful results from the use of antimony in cases of this latter disease, and Spanish observers have since given it in phagedaenic chancre. It has recently been found of use in Kala-azar and has been tried in cerebro-spinal fever. The empirical use of antimony by Fothergill and others in chronic

the rank atmosphere of a goat or a fox " was sometimes tried. Med. Obs. & Inq. iii. 281. Pereira (1839) used tcirtar emetic.

40 FOTHERGILL AS A PHYSICIAN chap, iv

conditions, due no doubt many of them to infections, and the long repute of Plummer's pill in old syphilitic and other cases, bid fair to obtain a rational justification.^

^ On the use of antimony by the ancients see 2 Kings ix. 30 ; Is. liv. 11, R.V. marg. ; Jer. iv. 30 ; Ezek. xxiii. 40. The name of Job's third daughter, Keren-happuch, signifies " Horn of Eye-paint." The " eye-salve " of Rev. iii. 18 is thought by Ramsay (Letters to the Seven Churches, pp. 419, 429, and note) to refer to the Collyria sicca made from Phrygian powder, for which, he says, the medical school at Laodicea was famous, and which not improbably con- tained antimony. See Galen, De Sanitate Tuenda, vi. 12, ed. Kuhn, vi. 439 ; Paulus ^gineta, Syd. Soc. iii. 357. Respecting the modern practice, the Currus Triumphalis Antimonii, imder the name of " Basil Valentine, a Benedictine monk of Erfurt," is now proved to have been written about 1600 : see English translation with notes by Kirkringius, 1678 ; American Journ. Med. Science, 1841, p. 136 ; and Roscoe and Schorlemmer, Chemistry, 1913, ii. 963. See also the well-known pharmacopceial works of the last three centuries ; Sydenham, Aled. Obs. ; A. Billing, Principles of Medicine ; Sir T. Watson, Lectures ; Trousseau, Lectures, iii. 346 ; T. K. Chambers, Lectures, pp. 207, 229, 250 ; Elliotson, Harveian Oration, 1846 ; Cushny, Plimmer, etc., in Proc. Roy. Soc. Med., 1907, etc. ; Tsuzuki, in Deutsche med. Wochenschrift, 1913, p. 985 ; Brit. Med. Journ. and Lancet, numerous recent references.

CHAPTER V

fothergill's medical practice, a case in consultation

If your work is first with you, and your fee second, work is your master, and the Lord of work, who is God. But if your fee is first with you, and your work second, fee is your master, and the lord of fee, who is the Devil. — Ruskin.

So will we in our work, whether here and now, or everywhere and always, have one end and one design — the promotion of the whole science and art of healing. — Sir James Paget, i88i.

Fothergill's practical instinct is illustrated by a special study, undertaken early in his career, of the diagnostic signs and approved treatment of those disorders whose attacks are sudden in their onset. Of tropical diseases, again, he was not without experience. He directed Smeathman to treat fevers in West Africa with an emetic, followed by cinchona in large quantities, given between the fits, and Epsom salts if necessary. In fluxes fowl- broth was to be taken largely, and after the bile had been freely discharged, anodynes.

Emulsions of insoluble drugs had generally been made by means of yolk of egg, an unsatisfactory excipient, for it often disagreed in digestion, sometimes became rancid, and it was besides expensive. Oils were often mixed with a volatile alkali or with spirit of wine. Mucilage of gum arabic was slowly coming into use for emulsifying. Fothergill's attention was drawn to it by his friend Rutty of DubUn, and finding the method good, he induced J. Bogle French, a London apothecary, to carry out a series of experiments with various excipients, in order to ascertain which were the best emulsifiers, and in what proportions they should be used. Fothergill brought the results in detail before the Medical Society (of Physicians) in 1757. It was shown that gum arabic was the

41

42 FOTHERGILL'S MEDICAL PRACTICE chap

most effective agent ; next to this, quince seeds, then gum tragacanth, and after this the syrupus altheee. Mixing in a mortar by attrition produced a much more stable emulsion than simple agitation. Oils of olive, almond, and cloves, balsams of copaiva, guaiacum, Tolu, and Peru, sty rax, benzoin, musk — even beeswax and spermaceti — all formed good and mostly palatable emulsions with the gum arabic. Acids could be added if desired. After this time the mucilago acacicB was much more largely employed.^

Fothergill was commonly among the foremost in putting new and improved remedies to trial.

Hemlock, then known by its Latin name of Cicuta, was extolled in 1760 by Dr. Storck of Vienna as a cure for cancer. For a time everybody prescribed the drug, but it soon proved to be of little worth. Fothergill tried it in many disorders, and found that it mitigated pain in tumours and neuralgias — its value in tic-douloureux will be noted later — and he thought that it checked the progress of ulcers. He was accustomed to begin with a small dose, 20 grains or less of the extract in the day, and to increase it even to 70 grains or more, until toxic symptoms came on — giddiness, eye movements, nausea, and tremor. It seldom produced benefit until given in as large a dose as the patient could bear. The extract varies, he says, in strength : it is important that it should be made when the plant has reached its full vigour and is rather on the verge of dechne, the fruits observable, and the foliage inclin- ing to yellow ; and very httle heat must be employed in the preparation. Modem investigations have confirmed the uncertainty of the virtues of this plant (to which Linnaeus restored the Greek name of Conium), and have led in the present day to its almost entire neglect. ^

Cinchona, then called Peruvian bark, was a popular

^ Experiments in mixing oils, etc., with water, by means of a Vegetable Mucilage; Works, ii. 25, iii. 188; Med. Obs. (S- Inq. i. 412. James Bogle, who added the surname French on his marriage to Elizabeth French, was an apothecary in Red Lion Square, and published with Fothergill's approval the " London Practice " of Physic (no copy traced in the British Museum). See T. Young, Med. Lit. p. 126 ; and Account of Dr. N. Hulme, Trans. Med. Soc. Lond., 1810, p. 238. He afterwards became a merchant in London. His will was proved in 1792. Through his daughters he was the ancestor of Horace and James Smith, and of Sir James Plaisted Wilde (Lord Penzance). Informa- tion kindly supplied by N. Bogle-French of York.

* Observations on the Use of Hemlock, read about 1768 ; Med. Obs. &■ Inq. iii. 400 ; Works, ii. 49 ; Cullen, op. cit. ii. 267 ; Woodville, Medical Botany, i. 65, 66 note ; Fluckiger and Hanbury, p. 299. Coniima is omitted from the British Pharmacopceia, 19 14.

V HEMLOCK AND CINCHONA 43

medicine, although it had been much opposed, and had little place as yet in the official pharmacopoeias. Sydenham was suspicious of it, thinking that it produced rheumatism. Boerhaave had an unconquerable dread of the bark, and even withheld it from students suffering from ague, to their grievous loss. Fothergill used it much. He records a series of cases, showing its value for scrofulous children with ophthalmia, enlarged glands and skin troubles ; he gave them as much of the decoction as they would take, adding calomel, antimony or other eliminatives at the same time, and a diet of broths and light animal foods. Some cases were uncured, especially if bones or joints were involved, but many yielded to a pro- longed use of the remedy. Fothergill was in the habit of prescribing a decoction of one ounce of the powder in from one to two pints of water, adding liquorice root, raisins or gum arabic before it was removed from the fire, to thicken the liquor and thus keep the powder in suspension. After strain- ing he added nutmeg water or spirit of lavender ; and with each dose of two to four tablespoonfuls, tincture of guaiacum, 10 to 60 drops, was to be taken, in order to reduce the astringency of the cinchona. Sometimes the winter's bark was combined with the other, so as to give the medicine a grateful warmth. For he hked the more aromatic and spicy barks — contrayerva was another favourite — belonging to the class then called " antiseptics."^ Balsams, resins and gums were also in frequent use.

Fothergill gave soap-lees {liquor potassce) in long-continued doses to dissolve stone in the bladder or kidney ; Mrs. Stephens' famous hthontriptic, purchased by parliament in 1740 for ;{50oo, had brought soap into repute for this disorder. He condemned the ordinary use of opiates in gout, and he avoided local applications (sedative or repressive) in this disease. A diuretic punch in a bad case of gout with dropsy was to be made with Spa water three parts, old hock two parts, and one of rum, with a little sugar ; sal-absinthii (potash) and bitters were also given, with an elixir of ammonia, paregoric and squill for the dyspnoea ; and a dose of Dover's powder at night. He was no abstainer from alcohol, though abstemious, and he writes in 1768 on the " pernicious custom " of drinking liquors between meals.^

^ On the Use of the Cortex Peruvianus in Scrofulotis Disorders, read 1756 ; Med. Obs. &■ Inq. i. 303 ; Works, ii. 3, iii. p. xlviii. Fothergill tried to procure a living cinchona tree, and seems to have had one in his garden, which, however, did not live long.

* One of the contentious and uncandid pamphlets of Dr. W. Rowley, A Letter to Dr. W. Hunter, iJT^, gives a series of prescriptions for a case of

44 FOTHERGILL'S MEDICAL PRACTICE chap.

He was a good letter-writer and a sage and persuasive counsellor. " Remember the motto I have so often given thee," he writes to his brother, sick of chronic gout, " Ne quid nimis (not too much of anything) ; write it in capitals everywhere." A gouty hon-vivant of an opulent family is to dine upon one dish at a time, and to choose that one upon the table which he likes the least. " Steady, steady, is a good sea rule," he counsels another who needs perseverance. Of a relative's ill-health, " Her disease was labour, and the cure must be rest." " We had at Bradford an inscription on a sign, Good Ale to-morrow for nothing " ; if the doctor's rules are broken to-day, empty is the promise of performing them to-morrow. " Quo simplicius eo melius " (the simpler the better), he writes to a physician who had consulted him about remedies. * ' Cito, tute et jucunde should always be the physician's motto."

Many distinguished persons placed themselves under him for medical guidance. John Wesley was one of these, and must have been a difficult patient, for he had strong views on his own treatment. In 1753 he showed signs of consumption — cough, pain, slow fever. Fothergill insisted on country air, horse-riding and rest from his incessant work. So he took coach for Lewisham, and that night wrote the well-known epitaph upon himself. Later he " broke through the doctor's order," and fell to his writing again. In the next year he took spells of treatment at the Bristol Hot-well by Fothergill's advice, and seems to have recovered of his lung trouble.^ Lord Clive was also a patient of Fothergill's ; he suffered from gall-stones, attended with spasms of severe pain, for which he was accustomed to take opium ; and the fatal event at Berkeley Square in 1774 was due, according to

cancer iinder the joint signatures of Hunter and Fothergill. They include Tinci. Thebaic, (laudanum) with crocus, peppermint and gum arable ; castor oil with cinnamon ; hemlock extract, 28 grs. in the day ; and sarsaparilla, with nutmeg and jalap. The Quaker's or Lancaster Black Drop was a strong opiate syrup in popular use in the eighteenth century, invented by Edward Runstall of Bishop Auckland. Acetum Opii, Pharm. Edin. & Dubl., was intended as a substitute. A. C. Wootton, Chronicles of Pliartnacy, ii. 145 ; Fothergill, Works, iii. 146.

^ Journal of Rev. J. Wesley, ed. 1903, ii. 294-300,

I

4

;\

^^

f^-A.

■&

/

\ >2^^

1

.1^

y

r.^-^>-.

,• ,"" '"BA

A MEDICAL CONSULTATION, 1770:

DRS. DAVID D'ESCHERNY, ANTONY ADDINGTON,

AND JOHN FOTHERGILL (right-hand figure)

From a Caricature Sketch by George Dance

V A CASE IN CONSULTATION 45

Horace Walpole, to his taking an extra dose contrary to his doctor's orders.^

It may be of interest to illustrate Dr. Fothergill's practice and the medical methods of the time by relating a case, the particulars of which have come down to us.

In the year 1764 he was consulted by his friend Dr. Cuming on behalf of a young lady of 27 years of age. She was plump, sanguine and of a lively disposition. Her physician stated that she had formerly suffered from a " pleu- retic fever," and that she was subject for several years after this to acute pains in the affected side, which were always removed by bleeding. There followed in succession amenor- rhoea, threatening of phthisis, ^wor alhus, and a violent hemi- crania. The latter disorder withstood, wrote her doctor, " the united force of the most efficacious medicines that I know, for almost a twelvemonth. It were endless to tell you the efforts I made. What expedient," he continued, " did I leave untried, what method unattempted ? At last I suc- ceeded." The hemicrania cured, the patient took a course of Bath waters, and continued well until about eight months prior to the date of consulting Fothergill, when she began to suffer from large alvine haemorrhages. Forthwith ten ounces of blood were taken from her arm, and astringents, balsams and laxatives administered, with anodyne injections, and dossils dipped in ointments. The cethiops mineral, a prepara- tion of crude mercury condemned by Boerhaave, was also prescribed, with testaceous powders, made from oyster shells. Her next symptom was a general miliary eruption, attended with a great itching, which required the exhibition of a purge and of more cethiops, followed by a course of Plummer's pill and a decoction of the woods, and later calomel. The local use of a lixivium (ley) of salt of tartar, white precipitate, and finally sulphur ointment resulted in the cure of the eruption. Violent alvine pains, with slight haemorrhages, had in the meantime occurred, and these dictated further venaesection and more injections, with laudanum and a decoction of comfrey. A small excrescence close to the sphincter, appearing to be the seat of acute pain, was removed. It would be tedious to enumerate all the many remedies employed, which included Locatelli's balsam, eryngo (sea hoUy), white poppy, copaiva and linseed, but in spite of all these means the paroxysms of local pain continued to afflict the patient.

^ H. Walpole, Letters, ix. 97, Nov. 23, 1774 ; Sir J. Malcolm, Life of Clive, iii. 371-373.

46 FOTHERGILL'S MEDICAL PRACTICE chap.

At this stage Dr. Fothergill's aid was sought for her rehef. He delivered a carefully reasoned opinion. It was tactfully suggested that the necessity of frequent bleedings had weakened the patient's habit and depraved her blood, and laid her open to a scorbutic acrimony, and to a varicose state of the hemorrhoidal vessels ; the hemicrania and the sphincter pains were in his opinion alike due to this acrimony in the blood, acting upon a habit debilitated by frequent bleedings. When proper appUcations had checked the haemorrhage and the pain, " the cause was thrown upon the skin, the part to which acrimonious humours are naturally directed." " It appears to me," so the doctor summed up his opinion, " that the properest method of cure would be to strengthen her habit in general, and promote the natural secretions ; to intermix gentle evacuations ; to make an artificial ulcer near the part affected ; and to attempt, by specifics, to correct the peccant acrimony." Alluding to diet and exercise, he forbade " garden-stuff, fruits, acids, salt, butter and cheese, in any quantity." Tepid water was to be drunk, and a glass or two of red wine allowed. A mild mercurial piU was to be taken, composed of the pure metal with guaiacum, almond oil, colocynth and liquorice. An issue was to be established capable of holding two or more peas. Sal Martis (sulphate of iron) made up in pills with anmioniacum, Venetian soap and extract of gentian, should be administered an hour before dinner, with a decoction of cinchona and winter's bark, mixed with compound wormwood water. When the eruption re- turned, she was to have a draught, in which a few grains of pilula Rufi (aloes and myrrh) were suspended by rubbing with rue and bryony waters and some syrup of saffron. The chalybeate purging waters of Scarborough were also advised.

This young lady recovered of her disorders, and lived to be a grandmother, enjoying good health. It is not difficult to see that in this case, which we should now describe as one of chlorosis, haemorrhoids, and neuralgia, Fothergill's instinct led him to a Une of rational and successful treatment. Avoid- ing the frequent venaesections, which had aggravated if they had not caused the disease, and discarding the powerful mercurial purges and innumerable herbal paUiatives which had been used, he placed the patient on a supporting basis, gave iron, cinchona and mild laxatives, and left the local trouble very much alone. ^

1 Works, iii. 131.

^

V HIS METHODS OF TREATMENT 47

As a young man Fothergill followed carefully the rules of his art, made use of the methods which he had been taught and prescribed the reputed specifics for various disorders. But as he went on he watched Nature's ways, learned the working of the human body, and came to think less of the maxims of authority and more of the results of observation — ^that which he could see with his own eyes, and infer from the facts before him. The general trend of his treatment was towards the support and stimulation of the vital processes ; and he gave a lesser place to the depressant methods in common use, such as bleeding, purging and blistering. These, indeed, he often used, but in selected cases and with some restraint. He placed blisters remote from the seat of pain.

All doctors probably tend to adopt a favourite line of diagnosis and treatment, and to find it appropriate to very many of their cases, especially those of chronic ill-health. Fothergill's inclination seems to have been to suspect the presence of acrimony, or as we should say acidity, as the cause of many disordered states. He treated it by a carefully ordered diet, in which limitation of the quantity of food, the use of asses' milk and the restriction of animal nutriment, of bread and of tea, generally found place. He prescribed at the same time gentle cathartics, perhaps also calomel, or mineral waters, following these with mild tonics, such as bark and iron. Perseverance in the course chosen was a cardinal point : gutta cavat lapidem. He remarks pertinently that remedies given by the mouth are liable to be altered in the stomach in their transit to the organs where they are to act. Hence the effects of chemical preparations depend greatly on the condition of the digestive passages at the time when they are swallowed. Therefore, he says, in the cure of chronic diseases consider the state of the stomach, and remove every obstruction in its office, enabling nature to do her own business. If digestion languish the best specifics may be of little use. Diet and regimen, including the use of air and exercise, were leading features in his treatment of most cases, and his care in regulating them

48 FOTHERGILL'S MEDICAL PRACTICE chap.v

was in his own belief a main cause of his success in practice. It was a day of large eating and drinking.^

Fothergill saw patients at his own house in the early morning and on two afternoons in the week. Lady Huntingdon tells a young friend to call " at nine or rather before," when there would be " a chance of seeing him. Press the doctor," she adds, " to take a guinea." He went out soon after that hour in his coach, not infrequently for the whole day, visiting patients, often meeting their apothecaries, and coming in for a short time at five o'clock to dine. On his return late in the evening he sat down to his writing till eleven or twelve.

Fothergill had a large medical and scientific library. Public collections of books were few in those days, and every man of letters or of taste who could afford it made his own.

In his later years he may have become old-fashioned, for he had no sympathy or approval for the " new style " of Macbride and Cullen, or for the systems in which their advanced knowledge was set forth.^ Looking back now upon his practice, bereft as it was of so many aids which to modern eyes seem essential to diagnosis, we may see, nevertheless, that he and the best physicians of his time had a strong and wise clinical instinct. They knew from a wide experience what Nature could do and what she could not ; their prognosis was generally sound, and it is probable also that their success in treatment was not so far behind our own as was their knowledge of pathology.

^ There is a tale of a Quaker druggist, who told the doctor he should bring his wife and family to be quartered in the doctor's house, because he prescribed no medicine, only exercise, diet and change, and the druggist was losing his living. See M. J. Taber, Just a Few Friends, Phila. 1907 ; and another version in Professional Anecdotes, 1825, iii. 288.

* Letter to Dr. Chalmers, Oct. 23, 1772 ; Bartratn MSS., Historical Society of Pennsylvania. Allusions to Fothergill's methods of treatment are scattered throughout his works, also in Lettsom's Memoirs.

CHAPTER VI

THE MALIGNANT SORE THROAT

Non fingendum aut excogitandum sed inveniendum quid natura facial aut ferat. — Bacon.

FoTHERGiLL is best known in medical literature as the author of " An Account of the Sore Throat Attended with Ulcers," a memoir published in the year 1748.

Epidemics of a severe form of angina had occurred in several parts of the country, and in particular had swept over London in the warm dry autumns of 1747 and 1748, and had carried off, not only the poor, but members of the highest families, including two young scions of the house of Pelham. Fothergill studied the disease closely, and worked out a plan of treatment for it, not of a depleting or depressing nature, as had commonly been practised, but generous and cordial. His paper deals first at some length with the history of epidemics of angina maligna in Spain and Italy during the two previous centuries ; these he illustrates by copious extracts and references. He then describes the symptoms and course of the disorder as they have come under his own observation. He paints the chnical picture of an acute disease, attacking whole families of children, as well as weakly adults, and proving fatal in many cases. It began with giddiness, rigor, fever, a quick pulse, severe headache, vomiting or purging or both, sometimes bleeding at the nose ; there was sore throat and stiffness of the neck. The fauces were of a florid red colour, and there were commonly ulcers or whitish patches on or about the tonsils. A skin eruption of a deep erysipelatous aspect generally came out on the second day, especially upon the face, breast and arms, down to the finger - tips. The white patches on the tonsils, if these were present, were at first thin and pale, but became ash-coloured, and later even black in hue, evidently consisting of sloughs, whose separation had been known to give rise to fatal haemorrhage. An acid

49 E

50 THE MALIGNANT SORE THROAT chap.

ichor flowed from them, and sometimes through the nostrils also. There was swelling of the parotid glands and neck ; and regurgitation of fluids sometimes took place through the nose. Ipsomnia and delirium were common. In those cases which ended fatally death took place by exhaustion, especially from persistent diarrhoea, or in some cases from suffocation, and generally before the fourth day of the disease ; but some patients dropped off unexpectedly after thirty or even forty days.

The diagnosis from a common angina depends, in Fother- gill's view, upon the severity of the initial symptoms, the vomiting or purging, acute headache, and the erysipelatous redness of the fauces with ulceration or sloughs ; also upon the skin eruption, seldom absent in children. But some cases are difficult to discriminate. He thinks the disorder is a general one, as contrasted with angina which is purely local.

As regards the treatment, he has found bleeding prejudicial and purging also ; all evacuations which tend to lessen the strength are injurious. Let the patient be kept warm in bed ; promote the early vomiting ; give aromatic cordials {contra- yerva, confectio cardiaca, saffron wine) ; check any continuing diarrhoea ; recession of the skin eruption, which is dangerous, is to be met by warmth and cordials ; a tendency to faintness to be watched against ; wine whey, chicken broth, barley water, etc., to be given ; blisters, on occasion, to be applied to the neck ; the sloughs on the tonsils not to be forcibly separated or scarified, but a free discharge of the corrosive matter to be encouraged by the use of stimulating antiseptic ^ gargles — sage tea, decoctum pectorale (a warm decoction of barley, raisins, figs, and liquorice), vinegar, myrrh, etc. — with which in severe cases the fauces should be very often and sedulously syringed, and especially before the swallowing of food ; large sluggish sloughs to be touched with the mel cegyptiacum (caustic copper acetate). For haemorrhage he uses clysters, vinegar applied by means of tents or in steam, also bark and opium. Asses' milk, bark and the elixir vitrioli (aromatic sulphuric acid) are useful in the debility of con- valescence. In later editions of his book he lays stress upon " free air," cleanliness and liquid nutriment ; bark in an enema with broth has, he thinks, saved many lives.

^ The term antiseptic (anti-putrescent) follows Bacon's earlier thought (Nat. Hist., Cent. IV.) and was employed by Boerhaave. It was becoming current at this period in English medicine. Fothergill's use of the word in 1748 is earlier than the first example given in Murray's Dictionary. See also Pringle's paper before the Royal Society, 1750.

VI A MODEL OF CLINICAL DESCRIPTION 51

FothergiU's account of the S5niiptoms and treatment of the disorder is fitly called by the late Dr. J. F. Payne " a model of clinical description." He describes in simple language what he has himself observed, and out of -a wealth of experience puts forward his conclusions cautiously, without dogmatism, recognising the limitations of his knowledge. Hence he has written very little which later research would lead us to reject. His style may be contrasted with the turgid and obscure diction still employed by many of his medfcal contemporaries. At the close he sums up his conclusions : that the sore throat attended with ulcers is a disorder of putrefaction, which affects the fauces in particular and the habit in general ; that it is due to a putrid virus, or miasma sui generis, which is introduced by contagion, principally by the breath ; that the effects of the virus vary according to its nature and quantity, and the predisposition of the subject ; that the disease is most effectually relieved by discharge of the peccant matter on the skin or other parts ; that the eruption is therefore to be promoted ; that a cordial alexi- pharmac, warm regimen is used with advantage, and that bleeding, purging and antiphlogistics are injurious.^

An attentive study of FothergiU's paper leads to the conclusion that he is describing a definite disorder, and not, as has been suggested, a mixture of cases of several different types. The same disorder was described by Dr. Cotton of St. Albans in 1749,^ by Dr. J. Wall of Worcester in 1751,^ by Dr. Huxham in 1757,* and especially by Dr. Withering,^ who studied it closely in Birmingham and wrote upon it at intervals from 1766 to 1793. Withering, who had known Fothergill well, became at length convinced that the " ulcerated sore throat " of the latter was the same disease as the Scarlatina Anginosa of Sauvage' (1763). Heberden,^ writing in 1782, considered it highly probable that the malignant sore throat was a form of scarlet fever. And this must be our verdict to-day : that FothergiU's disorder was one type of that variable infectious disease, which we know as Scarlatina ; of which a shght form was defined by Sydenham as Febris

^ Alexipharmac is a term applied to remedies against poisons, antidotes. FothergiU's enlightened views on contagion and isolation are illustrated by a letter to his brother about 1749, with directions how to deal with an outbreak of cattle plague. Tuke, p. 23.

■■^ Quoted by Withering.

' Gent. Mag. Nov. 1751, p. 497.

* Dissertation on the Malignant Ulcerous Sore Throat. ^ Account of the Scarlet Fever and Sore Throat, 1793.

• Commentaries, c. 7.

52 THE MALIGNANT SORE THROAT chap

Scarlatina; which occurred in severer forms epidemically, both then and often since ; forms which we now regard as manifestations of the same disease. Quasi - diphtheritic symptoms indeed attended Fothergill's disorder, as they occur in severe types of scarlatina at this day. But these S5nnptoms were exceptional, and the evidence shows that the disease defined by Bretonneau in 1821 as diphtheria was hardly known in Fothergill's time, at any rate in its pharyngeal form. Yet in the opinion of medical historians it had occurred previously, and the epidemics of angina in Spain and Italy which were the subject of Letherland's and Fothergill's researches were in fact diphtheritic.^ The complaint already called " croup " was better known and sometimes epidemic, but it was a lar)mgeal disorder, and thus clearly distinguished from other forms of angina.

Scarlatina, as has been said, occurred in Fothergill's time in occasional epidemics of varying t5^e. In the succeeding century it became a more common disease, of greater average severity and mortality, with a tendency to epidemic prevalence every few years. Outbreaks of aberrant types of tonsillitis, in which some cases cissumed a scarlatinal, others a diphtherial aspect, were common in Englsmd a generation ago. These facts suggest that certain diseases of the fauces were in Fother- gill's time less fully developed than they are now, that indeed new diseases were in course of formation. It is well to remember what we mean by a disease. What we Ccdl a disease is strictly the reaction of the human organism to a morbific cause. In common usage we combine the symptoms of the reaction with the cause itself, and call the whole a disease. The reaction varies with numerous factors, extrinsic and intrinsic. The cause, which Fothergill called in the language of his day a virus or miasma, we are accustomed in the case of many diseases to identify with a micro-organism, although the actual part played in the production of disease by the organism (in its possible transmutations) or by its toxins, or ferments, or by " secondary invaders," is not yet determined. When, however, such a cause has acted (it may be through countless generations of micro-organisms) upon many subjects, and has found a favourable environment

^ Bretonneau, Memoirs on Diphtheria, New Syd. Soc. pp. 31-37 ; Hirsch, Geog. and Hist. Pathology, iii. 76, 77. An outbreak of diphtheria (?) in the American colonies is described by Dr. Cadwallader Colden in a letter to Fothergill in 1753 : Med. Obs. & Inq. i. 211. See also Dr. James Sims, Scarlatina Anginosa in 17 S6, Mem. Med. Soc. Land. i. 388 ; Lettsom, 1793, Idem, iv. 280 ; and Fagge, Medicine, 3rd ed. i. 256.

VI THE EVOLUTION OF A DISEASE 53

to which it can adapt itself, it tends to produce a uniform reaction, capable of reproduction in other like hosts, and a specific disease with a defined course and symptoms is the result ; to this we give a name. There is some evidence for the belief that in Fothergill's time diseases of the fauces were in process of evolution, and that out of various epidemic types, one of which he so carefully described, the specific disorders well known to us have been developed.

Fothergill took great pains with the composition of this monograph, devoting every leisure hour to the task, and being, he tells his friend Cuming, much exhausted when he had finished it.^ In some of his views on treatment he followed the learned Dr. Letherland, whose retiring nature caused him to decline any reference to himself. In the preface to the fifth edition of the book in 1769, when Lether- land was no longer living, Fothergill acknowledged the debt.^

The paper came out at the right moment and was well received ; the 500 copies printed were sold off within a few weeks, and six editions were called for within the author's lifetime. His name became known and his practice widely extended. The paper was translated into French and into several other languages.^

The novelty and importance at this epoch of Fothergill's views on treatment may be illustrated by a " Letter from a Physician at Bath to Dr. Heberden " published in 1758.* In this letter the writer describes the " Malignant Sore Throat " attended with dark grey sloughs on the tonsils. He alludes to Fothergill without naming him, rejects his doctrines, and urges the use of bleeding, purging and scarifying the tonsils deeply, as well as giving the bark in large doses ; very few cases however in his experience survived. The old methods die hard ; even Fothergill's friend Gilbert Thompson in 1782

^ MS. Letter, Dec. 7, 1748. C. Roberts Collection, Haverford College, Penna.

^ A charge of plagiarism has been made against Fothergill on this slender foundation. See Elliot, Works of Fothergill, pp. iii-v ; Works (Lettsom), iii. p. xxix.

' Copies of the first and second editions of this work, boimd together in one volume, are preserved in the Library of the Royal Society of Medicine, London. The former contains marginal notes in Dr. Fothergill's handwriting. At the end of the volume is a list, also in his handwriting, of works dealing with the same topic ; with an autograph letter from Dr. And. Cantwell, dated Paris, 1749, which accompanied six copies of the translation into French of Dr. Fothergill's work, by M. de la Chapelle. The volume belonged to Alice Chorley of Tottenham, niece of Dr. Fothergill, and afterwards in succession to Thomas Thompson, Dr. T. Hancock and Dr. Thomas Bevan of London, and was finally presented to the Royal Medical and Chirurgical Society by Dr. Thomas B. Peacock.

* An imperfect copy is in the Library of the Roy. Soc. Med. Tr. D. 186, 16.

54 THE MALIGNANT SORE THROAT chapvi.

harks back to the use of depletion and purgatives in some instances. But FothergiU's treatise had a marked effect on medical opinion. His principles of treatment were widely accepted, and effected a great and beneficial change in practice. " How many lives were lost," wrote Withering in 1793, " until Dr. Fothergill and Dr. Wall taught us to withhold the lancet and the purge." ^

^ op. cit. p. 85. See also Mem. Lettsom, iii. 102.

CHAPTER VII

fothergill's other medical writings

A certis potius et exploratis petendum esse praesidium ; id est, his quae Experientia in ipsis curationibus docuerit ; sicut in ceteris omnibus artibus : nam ne agricolam quidem aut gubematorem dis- putatione, sad usu fieri. — Celsus.

This is the reason why the cure of many diseases is unknown to the physicians of Hellas, because they are ignorant of the whole, which ought to be studied also ; for the part can never be well unless the whole is well. — Plato, Charmides (Jowett).

Most of Fothergill's medical works consist of short papers embodying observations on diseases met with in the course of his practice.

Several of these disorders were at that date unrecognised,, and he was the first to point out the group of symptoms by which they were characterised. The papers are eminently practical, laying the chief stress upon treatment. The wording is often faulty, as though they were written, as indeed was the case with most of his writings, in the intervals of his busy labour when his mind was fatigued. But he writes as an observer of nature, taught by experience, and hence his work is but httle influenced by false medical theories which were then prevalent. His papers have in consequence a permanent value. They were read before the small Medical Society (of Physicians) of which he was one of the founders, and were published in the five volumes of Medical Observations and Inquiries. In order that his own name might not too fre- quently appear, his modesty dictated that some of the papers should be anonymous. Two early essays will be first men- tioned which were published elsewhere.

The Use of Emetics

As has been already stated, Fothergill took the use of emetics as the subject of his inaugural dissertation for the

55

56 FOTHERGILL'S MEDICAL PAPERS chap.

degree of M.D. Lettsom thinks it needful to tell us that it was his genuine production, since too frequently such papers seem to have been composed " by indigent individuals, who are always to be found in colleges," ready to furnish students at a price with a thesis which they are too indolent or ignorant to write for themselves. The treatise is couched in eloquent Latin, full of reference both to the ancients and to modems, and it demonstrates with the pardonable emphasis of a young writer the usefulness of emetics in a wide range of diseases and bodily conditions, especially in the sedentary habit. It is fair to add that he concludes with a list of disorders in which emetics should carefully be avoided.*

Ruptured Diaphragm — Congenital Syphilis

In 1744 FothergiU wrote a Latin letter, addressed to Dr. Mead {medicce juventutis pater atque princeps) and read before the Royal Society, describing the case of an infant dying in its tenth month, in whom was found a fissure in the diaphragm. Portions of the stomach, ileum, caecum, appendix and colon had passed through this fissure into the cavity of the thorax, Fothergill gives a minute clinical history of the infant's case, which is to modem eyes an accurate pen-portrait of congenital syphihs, then apparently quite unrecognised. It shows how closely and faithfully the young observer, although wholly without guidance from authoritative knowledge of the subject, could compose his records.^

Sciatica

Few diseases of the nervous system had been distinguished in the days of Fothergill, and those that were known were little understood until Marshall HaU and Duchenne had thrown clearer light upon nervous processes. One of Fother- gill's early papers deals with the treatment of Sciatica, a disorder which he avers has too often proved intractable by the remedies commonly used, such as bark, guaiacum and turpentine ; or by Fontanelle's blisters and caustics appUed externally. He has come to rely upon calomel, prescribing one grain of this drug in a piU to be taken nightly, with a draught containing opium and antimonial wine. After ten days' treatment the calomel is increased on alternate nights

^ The work was considered worthy of inclusion in Smellie's Thesaurus, 1778. * Epistola de Diaphragmate fisso, etc., Phil. Tratis. xliv. 11 ; Works, i. 21,

VII TUBERCULAR MENINGITIS 57

to two grains, and is further increased if needful, but seldom to cause tenderness of the gums ; as soon as the pain abates the anodyne is diminished by degrees. The opium acts, in his view; not only by controlling pain but by restraining the action of the antimony on the stomach and conducting it, as it were, to the remoter parts. The patient is not generally confined within doors. Fothergill states that cases of genuine sciatica seldom fail to yield to this treatment in the space of a few weeks, and that the complaint rarely returns.^

Hydrocephalus Internus [Tubercular Meningitis]

A distemper, of which Fothergill saw about one or two instances yearly, was then obscurely alluded to by medical authors as Hydrocephalus internus. In 1768, whilst he was proposing to himself to write an account of it, the Observations on the Dropsy in the Brain by that acute observer of nervous disorder, Whytt of Edinburgh, were posthumously published. Fothergill brought forward his own paper in the same year, a paper which Vicq d'Azyr calls " un des tableaux les plus finis que Ton ait jamais traces en medecine." His clinical picture is in several respects fuller than Whytt's, and, differing from that author, he lays stress on the often sudden onset of the disease in children or young adults, who appear, he says, to be healthy and active, sometimes " the favourites or sole hopes of their parents."

He traces its course : the drooping in some cases for a few days, access of fever, costiveness, pains about the nape and limbs, headache from temple to temple, deep and tense, and persistent vomiting ; the pulse at first slow, unequal in force and time ; irregular suspirious respiration — " sometimes they only seem to breathe in sighs for some minutes together " — (compare Cheyne-Stokes respiration) ; the wakefulness and startings, the pupils dilated and at length fixed, the photo- phobia, the piercing scream, and the gradual lapse into unconsciousness — none of these features escape him.

As regar4s treatment Fothergill confesses his impotence to cure. He begins with calomel, rhubarb and scammony, and perhaps tartar emetic. Anthelmintics are then given ; but unless these relieve, the disorder goes on to a fatal end, in despite of blisters and sinapisms. He urges the duty of inspecting the body after death ; we must not despair, he writes, of ascertaining the cause. He has himself found a

1 Med, Obs. & Inq. iv. 69 ; Works, ii. 77.

58 FOTHERGILL'S MEDICAL PAPERS chap.

collection of clear lymph in the ventricle of the brain in several cases, and he suggests tentatively the rupture of a lymphatic vessel from a fall or accident as a possible cause of the dis- order.^

Tic Douloureux

Fothergill was the first to describe clearly that form of facial neuralgia which was afterwards called Tic Douloureux. In his practice down to 1773, the date of his paper, he had met with sixteen cases. He marks the characters which distinguish the complaint from other painful affections of the face, from disorders of the teeth, from rheumatism, from ague in the head (malarial neuralgia), and from those fixed pains, worse at night-time, which are due to S5^hilis of long standing. The distemper, he says, attacks persons of forty years of age and upwards, and especially women. He describes the site and character of the pain, its paroxysms and how these are excited, and its rebelliousness to treatment — full doses of opium relieve, but the remedy becomes as troublesome as the disease. The extract of hemlock, gradually increased to a full dose, and persevered in, despite relapses, for many months, appears in his hands most often to bring substantial relief. He has a suspicion that the disorder is allied to cancer.

His nephew Dr. Samuel Fothergill, published in 1804 a more extended account of Tic Douloureux, describing it as an affection of the fifth pair of nerves and of the portio dura. Success with the use of hemlock was less frequent in other hands than Fothergill's.^

Hydrophobia

Hydrophobia was a very uncommon disease at this period, for Heberden, it seems, had never seen a case ; but it had lately attracted some attention. In one of his papers Fother- gill gives a minute description of a case in which he and

^ Remarks on the Hydrocephalus internus, read 1768. Med. Obs. & Inq. iv. 40 ; Works, ii. 63 ; Dr. R. Whytt, Observations on the Dropsy in the Brain, 1768. A fortnight after Fothergill's paper was read Dr. W. Watson described three more cases, in one of which the symptoms began two weeks after a blow on the head (Med. Obs. etc. iv. 78). Fothergill's paper was published in French : Remarques sur I'hydrociphale interne, tradmtes par de Villiers. Paris, 1807.

* Dr. J. Fothergill, Of a Painful Affection of the Face, Med. Obs. & Inq. V. 129 ; Works, ii. 179, iii. 163. M. Andrde of Versailles had alluded to the disease in 1756. Dr. S. Fothergill preferred the name Faciei morbus nervorum crucians : the Germans called it Dolor faciei Fothergilli.

VII HYDROPHOBIA 59

Watson had been consulted. The symptoms were of a typical character, developing four months after the bite of a cat, and they progressed to the usual fatal result. Fothergill, ever striving to cure, however hopeless the outlook, sums up his experience in the following advice. When the wound is received let it be cleansed with salt and water ; enlarge it by the cautery or knife, or by firing with a few grains of gun- powder, or still better by excision ; and promote discharge for a long time. Observe whether the bite was through any covering ; do not kill the animal, but confine it ; and assure the patient that the liability is remote. Should the disease develop, avoid all useless measures, however much reputed, such as sea-bathing, the Ormskirk or Tonquin remedies, Turbith mineral, or Mead's powder ; their apparent cures were in imaginary cases. Support the strength by much food, using clysters of egg and broth if needful. Soothe and relax the system by baths at 80° to 86° Fahr., which may contain bay salt or pot pourri ; the patient to lie in them as long as he is easy ; and baths and clysters to be repeated with perseverance. Mercurial ointment or inhalation of cinnabar fumes may be tried, also bleeding in moderation ; opium seems to be useless. But the outlook he confesses is an ill one, and those who are called to attend these cases should be bound by honour and the ties of humanity to record their experience fully, so that the field of conjecture may be contracted and new lines of investigation pursued.^

Epilepsy

Fothergill was not unsuccessful in treating some nerve complaints, little as they were then understood. In his Remarks on the Cure of the Epilepsy, written in the fulness of his clinical experience, he says he has tried the usual specifics for the disease, such as valerian, castor, the foetid gums and empyreumatic oils, besides mistletoe and cardamom flowers, but with many disappointments. Indeed he suspects that the disgusting taste of most of these drugs is the means of benefit when this takes place, by reducing the appetite and lessening the food taken. For diet is in this as in many other

^ Fothergill's paper, published in 1774 in the Med. Obs. & Inq. v. 195, was afterwards reprinted as a pamphlet with additions. See Works, ii. 221. Also Medical Transactions, Roy. Coll. Phys. ii. 46, 192, 222. Lettsom advised that a pointed stick of lapis infernalis (nitrate of silver) should be thrust into the opening made by the dog's tooth and worked deeply. Hints, iii. 224 ; Memoirs, iii. 144.

6o FOTHERGILL'S MEDICAL PAPERS chap.

disorders his main remedy. It is the plethoric type of the disease which he has in view, in persons who for the most part seem to be in full health, who eat largely and often incautiously ; if children they are highly indulged, or necessary exercise is neglected. He therefore recommends in many cases total abstinence from animal food and from fermented liquors. A course of mild laxatives is to be given and steadily continued, with a light chalybeate interposed ; riding, cold bathing and general hygiene must be pursued with patience, and these seldom fail of success ; small doses of opium only when fright or pain have to be countered. He finds tin filings, an ounce given daily in an electuary, and followed by a cathartic, to be a certain remedy for cases which depend on the irritation of worms.^

On Bleeding in Apoplexies

In the case of apoplexies, Fothergill writes, it is usual for the surgeon, if he finds the pulse full and tense, at once to bleed the patient. It is true that the persons most liable to this disorder are stout, short -necked and inactive, eating freely and often neglecting their evacuations. Bleeding in such persons seems a natural remedy, yet he thinks it is used too often. It might perhaps have prevented the attack and in some cases it may assist recovery by lessening the resistance to the heart's action ; but more frequently the copious drain reduces the strength, and nature's effort at revival is power- fully checked, the patient dying, or if he survives, suffering hemiplegia.

The common occurrence of a stroke after a plentiful meal suggests to him not so much plethora as that the distended stomach, by pressing on the descending aorta and obstructing respiration, has overfiUed the blood-vessels of the head. Instead of bleeding he uses emetics and purgatives, checking faintness by broth or wine, or giving repeated clysters if the patient cannot swallow, with sinapisms to the soles.

The bearing of a short neck on apoplexy is illustrated by the case of a young plethoric man with a very short neck, who was seized with a brief apoplexy whilst seated in a boat, and turning his head as the boat moved to keep his eye fixed on an object in the river. Fothergill shows that if a leather tube is

^ Med. Obs. & Inq. vi. 68 ; Works, iii. i66, 199. Dr. Anthony Fothergill suggested that the slight proportion of arsenic in the tin might be the beneficial agent. Lettsom relates a case of severe juvenile epilepsy, which he attributes to bony spiculas found projecting inwards from the vault of the cranium. Memoirs, iii. 72.

VII THE SICK HEADACHE 6i

twisted, its diameter is lessened in proportion as the tube is short. It is in this way that the jugular veins are contracted when a short-necked person turns his head, causing at first giddiness and then even apoplexy ; a tight collar aggravates the effect.

The practice of bleeding in apoplexies was too deeply rooted in the medical mind to give way to Fothergill's caution. It was not till some generations later that vensesection was restricted to a certain type of cases. After this, in the latter half of last century, bleeding was almost disused in England, although still mentioned in the text-books. Of late years more accurate knowledge of arterial and venous tension has led to bleeding being again resorted to with advantage, especially as a prophylactic, but also in some cases after the onset of cerebral haemorrhage.^

The Sick Headache

An essay of Fothergill's written in 1778 contains one of the earliest clinical accounts of the Sick Headache (Megrim), a disorder which had not yet attained a place in systematic medicine, and of which he knew something in his own person. Whilst incident to both sexes and at all seasons, it is found, he says, mostly in persons of early and middle age, belonging to the middle and upper ranks, who are of sedentary and relaxed habits, and eat incautiously. The onset occurs on first waking in the morning or later ; there is " a singular kind of glimmering in the sight, objects swiftly changing their apparent position, and surrounded with luminous angles, like those of a fortification." Giddiness comes on ; then headache of varying severity over one eye, or over both, sometimes on one parietal bone, or on the occiput. Sickness succeeds, in some cases only nausea, or a thin phlegm is vomited, or in others bile. Abatement of the pain follows, leaving soreness, uneasiness, and a wish for repose. After a short sleep the patient awakes well, only debilitated. Such an attack in a young person may last two or three hours ; as the years pass, it is apt to continue longer, twenty-four hours or more, and the patients suffer " with a violence scarcely to be endured ; the least light or noise seems to throw them on ♦the rack." The fits recur in some cases once in two or three

^ Considerations on the Practice of Bleeding in Apoplexies, read 1776. Med. Obs. & Inq. vi. 80 ; Works, iii. 208. Heberden had expressed similar if less decided views in 1767, Med. Trans, i. 472 ; Cyclop, of Pract. Med. 1833, i. 130.

62 FOTHERGILL'S MEDICAL PAPERS chap.

days, or in two or three weeks, or in as many months, or yet seldomer.

It is often treated, he continues, as a nervous distemper, but he thinks that the headache proceeds from the stomach, and that it is due to the effect in some constitutions of reiter- ated errors in diet, both as to the quahty and quantity of the food, associated with costiveness. He supposes that the aUment operates by altering the quahty of the bile secreted. Fothergill's treatment is to give an emetic, with warm water, and a mild cathartic to follow. Thus he prescribes aloes, with rhubarb and Uquorice root, infused in lime-water, and spirit of lavender ; also mineral waters drunk for a proper length of time. But dieting is of the first importance. Butter, especially when melted, fat meats, spices, black pepper, meat pies, rich baked puddings, and strong Hquors are harmful. In quantity, a just medium is to be found by abstaining at the first sensation of satiety ; the how much must be deter- mined by each individual.

He goes on to a review of English habits of diet. More people, he thinks, suffer by immoderate eating than by hard drinking ; the latter practice being now generally banished to the vulgar. He recalls that the famous Dr. Mandeville, when dining with the earl of Macclesfield, was often asked : " Doctor, is this wholesome ? " "Does your Lordship like it ? " "Yes." "Doesit agree with your Lordship?" "Yes." "Why then it is wholesome." Fothergill's own constitution, being " a good deal below the middle point of general strength," has obliged him to be careful in his own diet ; moreover, he has spent most of his life in observing the effects of food on the infirm and invalid. Different nations, he goes on, subsist on very various foods, yet enjoy reasonable health. In the East they live on rice and vegetables ; some nations on fish, others on mixed diets ; some use fermented liquors, some none. Our organs of digestion are so constructed that we can gradually accommodate ourselves to every species of ahment. But this is not the case in regard to the quantity of food ; if it is insufficient, we decay ; if too much, fatal oppression ensues.

The EngHsh meals, he says, are breakfast, dinner, and supper. At the first, tea, coffee or chocolate is drunk ; those who are not robust should limit the heat, the strength, and the quantity of these drinks, and little sugar should be added. As to the bread and butter or sugar which are taken at the same time, strong organs are requisite to digest much bread. The husbandman may do it, but in weak stomachs the bread

VII ENGLISH HABITS OF DIET 63

turns sour, produces heartburn, and should therefore be used sparingly. Butter also is often difficult of digestion, especially when toasted, fried or in sauces. Dinner, about noon, usually demands a well-covered table. Animal food suppHes the chief part, and vegetables and puddings should be in smaller quantity ; the latter if rich, sweet and baked often cause suffering. Fruit should not be taken after a plentiful meal but in the forenoon. Men should drink during the meal what health and inclination require, and not sit over the bottle afterwards. Wine after a full meal gives a temporary flow of animal spirits, but rather opposes the necessary assimilation of the food ; a mere diluent is preferable. No spirits should be taken, and the less of fermented liquors of all kinds the better ; " where water does not disagree, value the privilege and continue it." The novel practice of taking tea or coffee as a separate repast in the afternoon, before the digestion of the last meal is finished, is injurious, but an unsweetened cup without sohds may be drunk soon after dinner. Suppers, he writes, are now discouraged among the affluent, but it is a better practice for some, especially for those who have to give attention to business, to take two moderate meals, rather than a single large dinner. The supper should be light ; liquids are often ill bome.^

The Use of Coffee

Fothergill wrote a further notice of coffee. This beverage had been brought into Europe from Turkey in the middle of the seventeenth century, and coffee-houses after the manner of the east had become common in London. Duties and licenses were imposed to restrict them, and in 1675 Charles II. tried to shut them up as " Seminaries of Sedition," but they throve and multiplied in spite of all. The supply of the berries was a source of no Uttle wealth to the Arabians, but the plant was sent to Europe about 1690, and in 1727 the cultivation was introduced into the West Indies. In Fother- gill's time most of the coffee consumed in England camfe from those islands, but it was inferior (especially that from the EngHsh islands) to the Mocha product. Fothergill attributes this to the high duties charged, altogether is. lod. per lb., discouraging its culture. He urges the reduction of the duty

^ The Remarks on the Sick Headache were read before the Society ot (Licentiate) Physicians, an unrevised paper ; the diction is wanting in order and style. Med. Obs. & Inq. vi. 103 ; Works, ii. 320, and iii. 219.

64 FOTHERGILL'S MEDICAL PAPERS chap.

in the mutual interests of England and of its plantations ; smuggling would be discouraged, the consumption would be greater, and the revenue in consequence would not suffer.

Tea, coffee and chocolate compete, he says, for our prefer- ence ; tea at present taking the lead. Fothergill personally inclines to coffee. Letters from the West Indies tell him how much coffee is used by the French, contributing to their vivacity. " Coffee and scalded milk with a crust of bread," would surely, in Governor Scott's humble opinion, " be one of the best breakfasts in the world for the honest brave people of the foggy island of Great Britain, where such a multitude of melancholy accidents happen from a lowness of spirits." ^

On Tapping in Dropsies

Another paper relates to the early use of tapping in dropsies. Fothergill begins by remarking on the foUy of applying remedies when too late to be of service, and goes on to show that the operation of tapping has fallen into disrepute on this account ; few patients, he says, survive its employment because it is not used early enough. His own practice is to use diuretics, such as squills, purgatives (salts), and corrobor- ants (balsams) for a time. But if no benefit accrues, if also the viscera appear to be sound, if there is no history of in- temperance and if strength is adequate, he makes a pause, until the signs of ascites become so evident that tapping can be safely performed. After this has been done the diuretics, chalybeates, and bitters have again a fair chance, for the vessels have recovered their absorbent power. He does not make incisions in anasarca, preferring the use of the scarificator, by which small transverse cuts are made in the skin.^

Painful Constipation

Elsewhere Fothergill deals with Cases of Painful Constipa- tion, masked by apparent diarrhoea, due to rectal impactions ;

1 Extracts from The History of Coffee by J. Ellis, with a botanical descrip- tion by Dr. Solander, and a figure of the plant : also extracts from La Roque's Voyage; a Letter (dated 1773, from Dr. Fothergill) on the Culture and Use of Coffee ; and Observations on Coffee commiuiicated by Governor Melville, and by Governor Scott of Dominica, 1765 ; also notes by Lettsom ; all in Works, ii. 280. See also Ellis's Letter to Franklin, 1773, Anter. Philosoph. Soc. Calendar, iii. 181 ; and Dr. T. Percival, Essays, ii. 122. Fothergill had some coffee-trees growing in his garden at Upton. The largest, about 15 feet high, fruited in full berry in 1783, being then in Lettsom's garden at Grove Hill.

* Med. Obs. & Inq. iv. 114 ; Works, ii. 85.

vii THE CURE OF CONSUMPTION 65

a condition sometimes set up by the use of bark or other astringent tonics.^

Consumption. The Climate of London

Fothergill wrote several papers on the cure of consumption, the outcome of a large experience. His first purpose is to enter his protest against the abuse of balsams such as copaiba, tolu and benzoin, then much prescribed for this disorder. Their use in embalming may have led people to infer that they had efficacy in preserving the living also from corruption and decay. They may be good, he allows, in cold serous habits in advanced age, and they may have antiseptic efficacy against purulent ulceration, but (and here he disagrees with Fuller) their heating and acrid qualities are improper when inflamma- tory signs are present. He traces the clinical signs of chronic phthisis, not omitting the patient's " nails bending over the ends of his fingers," and points out that its victims are many of them marked by " excellences both of body and mind," which would have made them conspicuous ornaments of humanity. Treatment, he says, is chiefly of use at the beginning. Influenced by a theory that the quantity of blood passing through the lungs should be moderated, he advises limiting solid food, and gives no meat nor fermented liquors, preferring milk, or where this disagrees, whey ; the addition of rum or brandy has done much mischief. He lays stress on general regimen ; the avoidance of anxiety, fatigue and dissipation ; the keeping of regular hours, with moderate exercise ; horse-riding, which was Sydenham's prime remedy, is useful within limitations.

As regards drug treatment he condemns such mischievous nostrums as " Godfrey's Cordial " and " Bateman's Drops." He thinks that bark, indicated as it is by the symptoms of an intermittent hectic, is too freely used, but he finds it valuable in certain classes of cases. The Elixir of Vitriol (aromatic sulphuric acid) combined with tincture of roses is good in the later stages of the complaint. He has also tried in some cases the antiseptic effect of inhaling the vapour from boiling brine in the salt-works. Repeated small bleedings are useful

^ On Painful Constipation from Indurated Faces, an anonymous paper read 1768. Med. Obs. & Inq. iv. 123 ; Works, ii. 99. The local examination and the treatment — mechanical removal by the finger, or by the aid of a tallow candle — was carried out by the apothecary or his servant at the request of the physician.

F

66 FOTHERGILL'S MEDICAL PAPERS chap.

in inflammatory and plethoric subjects, but he utters a warning against excess. The Bristol waters have an extraordinary reputation in these disorders ; the annals of the hot wells indeed show a large mortality, but this he thinks is because the patients come too late. He has seen many persons recover after drinking the water, and advises a trial in the early stage of the disease. Much of the benefit may, he admits, be due to travel and change, nor is it of little consequence that the patients should be obliged to be out of their rooms early in the morning in the cool fresh air to take the waters.

Perhaps the chief interest attaches to Fothergill's remarks on change of atmosphere and cHmate. A journey of itself is helpful ; the fresh scenes stimulate hope in the patient's mind. The air of all large cities is injurious to consumptives. They should resort to a spot where the soil is dry and the water is good ; where neither stagnant pools nor thick woods abound ; it should be airy but not stormy, nor exposed to the north-east ; and sheltered walks and rides must be available. He goes on to examine the climate of London. The town, he says, is surrounded by a ridge of eminences which enclose besides the city a low plain to the westward. On the north are Highgate, Hampstead and Kensington gravel-pits, on the south Blackheath, Clapham and Putney. Over the town itself hovers a dense body of smoke which spreads for several miles beyond the suburbs (then of small extent) and covers the herbage with soot. In summer the prevailing winds drive the smoke northward, whilst in the winter the cold winds from that quarter move it to the south, and their rigour is softened by passing through the warm smoky atmosphere. Consequently vegetation is earher to the south and south-west of the city ; for example, he has seen the double almond tree in bloom at Chelsea twelve days earher than in the north or east. In spring time the climate of many parts of London is too exposed for consumptives ; they should stay preferably in the vales on the south and west, as CamberweU, Peckham, the lower parts of Clapham, the drier parts of Lambeth and Battersea, or Chelsea ; on the other hand, to send such persons in summer to the low marshy banks of the Thames amongst the gardeners' grounds is most improper. Islington, " the general refuge of the city," is open to the north-east, and is moreover smoky in summer.^ As regards other parts

^ It is said that Fothergill had a high opinion of Mitcham, calling it the Montpelier of England, from its salubrious air. It was a place of many physic gardens, and patients were sent there when the camomiles were in full bloom. E. J. Hartley, Mitcham in Days Gone By, 1909.

VII THE CLIMATE OF LONDON 67

of England, Fothergill sends his patients, he tells us, in the spring to the south or west country or to the sea coast ; and in summer to the north, or to Wales, Buxton, Matlock, etc.

Of continental resorts for phthisis he says with regret that but little is known ; they should have a short mild equable winter, and be of easy access. The south of France (Nice and near Marseilles), Italy (near Naples), and Portugal (near Lisbon and Cintra) are most resorted to. Madeira is more equable than these, but the voyage is a hindrance. Above all, let not the journey be undertaken when the disease is advanced or the season unfit.

Fothergill's treatment of consumption shows his clinical instincts at their best. His proposition to diminish the blood-flow through the lungs would now find Uttle favour, yet in some plethoric cases it might promote a cure by fibrosis. He makes no contribution to the pathology of the disease, evidently follo\ving himself the views of Richard Morton ; for he makes some allusion to heredity, and speaks of the disorder as for the most part taking its rise from an accidental cold. It is to the French school, commencing with Desault, that we chiefly owe the doctrine of tubercle.^

The Management of the Climacteric

A paper which continued to be read long after Fothergill's time, and was translated into French, dealt with the manage- ment proper at the climacteric period. Rejecting the old theories on which this management had been based, and yet knowing little of the mechanism of ovulation, Fothergill lays down a plan of treatment which is essentially symptomatic and based on experience. He defines clearly, amongst other conditions, the plethoric state, and the irritable or nervous habit, and adjusts his remedies according to the needs of each ; here eliminants and cathartics, there astringents or anodynes ; and above all, such regulation of diet, drink and general regimen as he had found useful in the differing conditions. His chnical pictures of some of the various disorders, real or

1 Med. Obs. & Inq. iv. 231 (1769) ; v. 345 ; Works, ii. 115, 127; iii. 154, 179 ; Proc. Roy. Sac. Med. iv. Epidem. Sect. pp. 153, 154. Lettsom (writing in 1812) states that about 1770 the faculty of Paris enquired of the College of Physicians in London whether the frequency of consumption in this city was due to the use of coal-fires ; and that Fothergill told him the question was answered in the negative, since it was just as frequent where peat or wood was used as fuel. Since that time, he adds, the disease has spread over the continent and still more in America. Mem. Lettsom, iii. 211, 348.

68 FOTHERGILL'S MEDICAL PAPERS chap.

imaginary, which occur at this period of Hfe, might easily have been drawn to-day.^

Obesity

" A strict vegetable diet," FothergOl observes, " reduces exuberant fat more certainly than any means I know." Two striking examples follow, in which this regimen and the limitation of alcohoHc liquors effected a cure. One of these patients, a lady who could with difficulty walk across the floor of her apartment, was sent to drink the Scarborough water, until she was able to climb the ascent to the spa.^

Angina Pectoris

Two papers were written by FothergiU on Angina Pectoris, a disorder which had only lately been defined and named by Heberden, although isolated cases may be found in the records of Morgagni and others. Fothergill describes two cases, out of many that had come under his notice, in which he had been able to obtain a post-mortem examination. The clinical history is related with fulness by his graphic pen, including the special characteristics of the pain, the effect of sudden agitations, whether from passion or exercise, the influence of a fuU meal, and of states of the weather, and the frequent association with a gouty habit of body. Of the autopsies on his two patients, the first was inconclusive ; the second was performed by John Hunter — it might have been a forecast of his own tragical end — and revealed, besides pleural effusion, much evidence of " ossification " in the structures of the heart. The substance of the ventricles was pale, ligamentous, and in parts whitish and hard ; the mitral valves were stiffened and contained many similar patches ; there were ossifications in the wall of the aorta ; and " the two coronary arteries, from their origin to many of their ramifications upon the heart, were become one piece of bone."

This seems to be the earliest dated record of lesion of the coronary vessels in a case of angina pectoris. Jenner and Parry made further observations, and coronary atheroma and its results were in course of time recognised as the char- acteristic lesions of one type of angina, whUst Heberden's

^ Of the Management proper at the Cessation of the Menses, Med. Obs. & Inq. V. i6o ; Works, ii. 201 ; Conseils aux Femtnes, etc., 3 editions in France ; the 2nd, Paris, 1800, was enlarged by Petit-Radel.

* Med. Obs. & Inq. v. 248, 250 ; Works, ii. 260, 261.

VII ANGINA PECTORIS 69

original theory of spasm was developed by Trousseau and others, who discerned the neurotic nature of the disorder, as well as its anatomical basis.

When Fothergill comes to the question of the treatment of angina his resourcefulness contrasts with the brief recom- mendations of Heberden. He lays stress, as is his wont, upon diet ; spices and aU heating things are to be shunned ; food is to be sparing in quantity, and animal food to be abstained from so far as health permits ; httle fermented liquors should be taken. Temperance and moderation are enjoined in the habits and work of life ; guarding against passion, anxiety or any vehement emotions ; with some exercise on horseback in suitable cases. The emunctories are to be attended to, and gentle laxatives employed ; to disperse flatulence and control distension of the stomach, warm cordials are proper, especially peppermint ; bitters should be taken for a fortnight at a time, and sometimes a mild chalybeate ; Fothergill gives soap and native cinnabar pills to one patient. If needful an anodyne of opium and antimonial wine may be taken at night. The Bath waters may be drunk in the summer time. The scheme here outlined would still form a good basis of treatment, to which the further and more potent means which modem knowledge has supplied could be added.^

Pigment Poisoning

Colica Pictonum, or of Poitou, had long been known as a disease, the cause of which — poisoning by lead — was demon- strated in a masterly paper by Dr., afterwards Sir George Baker in 1767. A few years after this Fothergill brought forward cases of artists in water-colours who suffered with symptoms of poisoning, due, as he showed, to their placing the brushes charged with metallic pigments between their Hps in the course of their work. He tells of violent colic and constipation ; of feebleness of the hands ; again, of exquisite pains in the soles of the feet, of loss of speech and

^ Fothergill's papers on angina pectoris seem to have been read in 1774 and 1775. See Med. Obs. & Inq. v. 233, 252, and Works, ii. 249, 263 ; Heberden (1768) in Med. Trans, ii. 59, iii. i, 12 ; and his Comment. (1782), c. 70. Rougnon, 1768 (see Osier, Angina Pectoris) ; Parry, Syncope Anginosa, 1799. See also Ccslius Aurelianus, Chron. ii. i ; Morgagni, De Sedibus, ii. Ep. xxiii. 8, xxvi. 31 ; Mem. Lettsom, iii. 46 ; Trousseau, Clin. Mid. i. xx. Seneca was probably the subject of this disorder, which has struck down some men of the strongest and keenest minds, such as John Hunter, Dr. T. Arnold, Matthew Arnold and Dr. Chalmers.

70 FOTHERGILL'S MEDICAL PAPERS chap.

mental prostration. He suspects the presence of arsenic, as well as lead or copper, in some of these cases. In a note he adds that he has found similar pains in the feet as the almost constant companion of dram-drinking, especially in women ; this may be the earliest allusion to alcoholic neuritis.^

Ipecacuanha in Diarrhcea

Ipecacuanha was then commonly and freely used in cases of Chronic Diarrhoea. In the last of his medical papers Fother- gill states his own method of using the drug in small and infrequent doses. He gives one or two grains only, early in the morning ; this has either an emetic or cathartic effect, which is assisted by a basin of thin gruel. The dose is repeated daily or at longer intervals, and a cordial anodyne is taken every night to insure digestive quietude. The cure partly depends in Fothergill's view on the diaphoretic qualities of the drug, since these throw off through the skin the acrimony, which is a cause of the diarrhoea. The food should be regulated especially in quantity, and animal food restricted to one kind only ; thus a cure ensued in a patient who dined off mutton for a month continuously. A long course of gentle tonics, bark or iron, is helpful ; besides it enables the doctor to keep control of the regimen.^

Influenza

Influenza was a disease well known to Fothergill. Again and again in the middle part of his century — in 1762, in 1775, in 1782 — was it epidemic in Europe, sweeping rapidly over whole countries, and burning itself out, as it were, in a few weeks. Fothergill studied the outbreak of October and November 1775, which smote half London with catarrh. He is said to have had sixty patients on his own daily list. Directly it ceased he drew up a concise " Sketch of the late Epidemical Disease," under heads, which he printed on four pages of letterpress having very wide margins, and circulated it among his medical friends in town and country, begging them to add their own observations, so that a more complete history of the distemper mighj; be obtained. RepUes were furnished by

^ Observations on Disorders to which Painteis in Water- Colours are exposed, read 1775. Med. Obs. & Inq. v. 394 ; Works, ii. 269 ; Med. Trans, i. 175.

* On the Cure of Fluxes by Small Doses of Ipecacuanha, read Aug. 21, 1780. Med. Obs. & Inq. vi. 186 ; Works, iii. 245.

vn INFLUENZA 71

Heberden, Pringle, Baker and Revell Reynolds in London, by Cuming and Pulteney in the west, and by Ash of Birming- ham, White of York, and Skene of Aberdeen amongst others. A considerable body of evidence agreed as to the course of the complaint ; its sudden onset, attacking first domestic servants, and then often entire households ; the giddiness, headache and other pains ; the acute catarrh of nose and throat, some- times of digestive organs ; the fever and quick pulse ; the frequent and teasing cough, often continuing after the other s5anptoms had subsided ; the intermittent flushing and sweats in some cases ; and the languor and mental depression which followed, out of all proportion to the physical illness. Some were able to keep about ; others were laid up for a few days. A scarlet eruption, otalgia, and sloughs on the tonsils occurred in a few cases.

The distemper was remarkable for its suddenness and universaUty. Thus Dr. Glass wrote that all the servants and patients in the Devon and Exeter Hospital excepting two children were seized within a week ; and few of the 200 inmates of the Exeter Workhouse escaped. At Chester it was recorded by Dr. Haygarth that, in a street of affluent residents, 73 out of 97 suffered ; in one of tradespeople, 109 out of 114 ; whilst the 175 occupants of the Home of Industry were all affected. Many children were attacked, also old people ; and to some of the very young, the old and the weakly, it proved fatal ; otherwise the mortality was very slight.

The patients were treated with warmth, diluents, dia- phoretics, purgatives and nutritious food. Some doctors used bleeding ; Fothergill did so in sthenic cases ; others thought this harmful. Bark was generally found useful in the later stages.

It was established in various places that horses and dogs had suffered a few weeks earlier than men, and that a good many dogs, after showing signs of giddiness, anorexia, fever and paralysis of the hind legs, had died. Fothergill tried to connect the outbreak with weather conditions, but with no success, excepting that the disease appeared to be checked by a sudden frost.

These eighteenth-century epidemics of Influenza in England were followed by a long pause, broken only by the slighter outbreak of 1803, until the severe visitations of 1830 and 1847 ; after this again there was another almost entire cessa- tion until 1889. At the latter epoch the relationship of infective germ and host seems to have become altered, for

72 FOTHERGILL'S MEDICAL PAPERS chap.

immunity is no longer produced with any regularity, and so the disorder is ever amongst us.^

Weather and Disease

Following Sydenham's endeavours to discover the relation between weather and disease, Huxham, FothergiU, Cleghom and others sought by patient and continuous observations to accumulate records upon which such relations could be established. During four years, from 175 1 to 1754, Fothergill made observations in London of the barometer and ther- mometer, the highest and lowest readings and daily range, with the direction of the wind, the rain, etc., recording at the same time the diseases which were prevalent. These records he communicated anonymously once a month to the Gentle- man's Magazine, in the hope of inciting others to the same enquiry. A steady course of one kind of weather, and again, quick transitions from one kind to another, might, he thought, have an effect in promoting certain diseases. Moist and moderately warm seasons were, according to his observation, the least disposed to produce acute diseases. Some of his incidental notes on current disorders are of interest, as for example on an epidemic of jaundice in children, and on inflammatory bowel disorders occasioned by eating great quantities of walnuts, then very plentiful. Again he laments the early treatment of slow fevers by bleeding, bhstering and sweating, so that the sufferers came enfeebled under the care of the physician.

Medical observers of the weather at this period did not effect much beyond confirming Sydenham's conclusions as to the prevalence of respiratory and digestive catarrhs at some seasons of the year. Since FothergiU's time much more

^ A Sketch of the Epidemic Disease, which appeared in London towards the end of the year 177s, Med. Obs. & Inq. vi. 340 ; Works, iii. 251. A copy of Fothergiil's circulated Sketch is in the MS. Linnean Correspondence, Linn. Soc. The disorder was then known as the Epidemic Catarrh, or Febris Catarrhalis, although the Italians had already called it Influenza from the supposed influence of the heavenly bodies. Dr. T. Glass thought that the pestilence described by Homer as spreading in 9 days through the camp of the Greeks and then disappearing must have been Influenza. A prescription of Haygarth's may amuse the learned reader : Tartar Emetic gr. |, adis. horis ad sursum vel deorsum purgandum. On the occurrence of the next epidemic in 1782 the College of Physicians collected information from practitioners in the kingdom, much as Fothergill had done, and an account of the disease was drawn up by a committee of the college. See Med. Trans, iii. 54. Some curious notices of outbreaks in France in 1733, 1737 and 1743 are to be found in Barbier, Journals historiques et anecdotiques du r^gne de Louis XV. The disorder was called " Rhume Epid6mique " and " Grippe."

VII WEATHER AND DISEASE 73

accurate meteorological records and truer pathology have not enabled us to advance very much further. We know that pneumonia, measles, hooping-cough and scarlatina have an epidemic prevalence at certain seasons of the year, and that some of these occur in periodic cycles, but this is about as far as present knowledge has attained, and such obscure phrases as " Epidemic constitution of the Air " and " Pandemic influence " are still sometimes made use of.^

" Rules for the Preservation of Health "

This account of Fothergill's medical papers may be closed with an allusion to an imposture — a little book, " Rules for the Preservation of Health, by J. Forthergell " — which, greatly to Fothergill's annoyance, was issued by an enterprising book- seller. The work was compiled from Dr. Mackenzie's Rules of Health and from other sources, and it traded on Fothergill's high reputation as the supposed author, so that it passed through many editions and attained a large circulation. He informed the public in vain, time after time, of its spurious origin.^

^ On Weather and Diseases, Works, i. 145-240 ; Annual Med. Review and Register, 1808, p. 37 ; Dr. A. Ransome, in Proc. Roy. Soc. Med. iv. Epidem. Sect. p. 185. The notification of Infectious Diseases which commenced in England about 1890 will in time supply further and more reliable data.

* There were not less than fourteen editions, of the title-page at any rate. Med. Obs. & Inq. vi. 135.

k

CHAPTER VIII

THE DISPUTE WITH DR. LEEDS

He who overcomes others is strong, but he who overcomes himself is mighty. — L&o-Tsze, 600 b.c.

Calamitas virtutis occasio est. Illos merito quis dixerit miseros qui nimia fehcitate torpescunt. Hos itaque deus quos probat, quos amat, indurat, recognoscit, exercet. — Seneca, De Providentia.

Fothergill's medical and scientific life was singularly free from the misunderstandings and quarrels into which the scientists of his time, jealous for their own reputation and rights, were too often led. There is however one episode in his career which should not be passed over, because it has been made the cause of reproach to his character. We must disturb the dust which has long settled on forgotten records, but the story may illustrate the manners of the time, and the history of the society to which Fothergill belonged.

A certain Samuel Leeds, an illiterate man, who had been a brush-maker, succeeded in obtaining the degree of Doctor of Medicine from Edinburgh University in 1766 after attending classes during two sessions, and presenting as his own a thesis " De Asthmate Spasmodico." He was a member of the Friends, and on coming to London was taken up by his own community, and partly by their help elected a physician to the London Hospital in May 1768. Fothergill, himself an old and honoured Edinburgh graduate, was imbued with a sense of the dignity of a physician's degree, as indicating both a thorough medical training and a groundwork of classical and other learning. He was vexed that the diploma had been given to Leeds, the more so as he had reason to think that the professors had favoured him as an Englishman, a Quaker, and one supposed to be a particular friend of Fothergill. The

74

CHAP, vin A CASE FOR ARBITRATION 75

method of conferring degrees then usual did not always demand evidence of full qualification. When Leeds further obtained an important hospital appointment with responsible duties, Fothergill's disapproval was emphatic, and he expressed it in conversation at his own table to Dr. Dawson, a colleague of Leeds at the hospital, who was breakfasting with him. Take care, he said, of Dr. Leeds, that he do no harm to his patients.

It was not long before the governors of the hospital found cause for uneasiness. Fothergill's words, which seem to have been repeated, may have had influence. Complaints were made of Leeds' incompetence, and some subscribers threatened to withdraw their support. The governors of the hospital in consequence passed a resolution, that no physician should continue to hold office who had not obtained the Licence of the College of Physicians. Leeds was therefore obliged to present himself for examination, and having failed to satisfy the college censors had to resign his post in June 1770. Disappointed and discredited, he turned against Fothergill, ascribing the loss of his position to the doctor's action. As they were both Friends, he laid a complaint against Fothergill before the church authority, the " Monthly Meeting " of Westminster, in November 1770. That body, of which Fothergill was a prominent member, was naturally averse to taking up the matter ; a committee was however appointed, but the issue dragged on from month to month, and in the following April Leeds appealed to the superior body, London " Quarterly Meeting."

A weighty committee of fifteen Friends was set apart to consider this appeal, but, shortly after, both parties agreed to submit the difference between them to arbitration, according to the rules of the society, under bond of ;^2000 to abide by the result. Five Friends, Leonard Ellington, Daniel Mildred, William Smith, Lewis Weston and John Sherwin, were chosen as arbitrators, and Leeds and Fothergill were heard before them. Leeds' charges against Fothergill were three : that he had said that Leeds had obtained his diploma surrepti- tiously ; that he had bidden Dr. Dawson take care that Leeds did no harm to his patients ; and that he had told Lettsom that Leeds and another had brought some disgrace on the society, a statement repeated by Lettsom in a letter to a friend in Edinburgh. Fothergill replied that he might have said he had been informed that the degree had been obtained surreptitiously, and he could quote his informants (he after- wards obtained evidence of this on affidavit) ; that the advice

76 THE DISPUTE WITH DR. LEEDS chap.

to Dawson in conversation at his table was justified, and was only due to humanity ; and that his words on a hke occasion to Lettsom were also justified, as the degree had been given, he believed, by an undue condescension, to a person whom the College of Physicians judged to be unqualified.

Much to the surprise of Fothergill, the Friends arbitrating decided, by three voices to two, in Leeds' favour, casting Fothergill in £500 damages. The latter was now much perplexed as to his right course. For some time he thought of submitting to the decision, although he beheved that the award could be proved to be partial and unjust. But it seemed to be a pubhc duty to secure a more equitable judg- ment, and so clear the society from dishonour. Moreover, he had some grounds for objecting to the procedure. Time which he had requested for the production of a material witness had not been granted, and no damage had been proved to have accrued from his words ; the arbitrators themselves seem also to have given some countenance to an appeal to another tribunal. After careful consideration and advice he decUned to comply with the award, anticipating that the matter would be carried to the final church authority, the Yearly Meeting.

Leeds now applied again to the Monthly Meeting (November 1 771) to admonish FothergUl to perform his part. A few days after, he entered the award in the Court of King's Bench, for the issue of a Rule to compel the observance of the bond. Fothergill was not sorry to hear of this, since he felt that in a public court he should obtain justice. For his own protection it was needful for him to enter his defence at the Court during the same term, else it would have been excluded by law, and he would have been hable to imprisonment without bail. Leeds made this act of Fothergill's a fresh ground of complaint, and continued to move both the Monthly and Quarterly Meetings for satisfaction. During the period of two years, in which the matter was in agitation, it came up twenty times before the Monthly Meeting, and thirteen times before the Quarterly Meeting, often at special adjournments. Long sittings were held and some party spirit was shown. The most serious and able Friends in London laboured on com- mittees to adjust the difference. It would be injurious, so they felt, to the reputation of the society, that two of its members should be at variance in a public court of law. Much effort was therefore made, both in and out of meetings, to induce the parties to desist from legal action. Fothergill, though at first unwilling, and making conditions — that the

vni DISCIPLINARY PROCEEDINGS ^^

award should be quashed, and that points of law and of medical ability should be referred to counsel and to physicians respectively — yet afterwards agreed to submit the matter to be finally determined by the society. Leeds and his friends, however, stood upon the award, and he even maintained that he had not gone to law with Fothergill, but that the latter had filed affirmations to dispute his right, and he declined to withdraw his plea from the Court.

Despite therefore all that Friends could do, the cause came on before the Court of King's Bench in May 1772. Leeds was heard, and when his case was finished, the court intervened, and declined calling on Fothergill's counsel. Lord Chief Justice Mansfield stating the unanimous opinion of the judges, that the award must upon Leeds' own evidence be set aside as partial. The judge exposed poor Leeds' ignorance to public derision, and expressed himself strongly, that Fothergill had only done his duty in the remarks that were complained of. This decision seemed to be conclusive. Nevertheless Leeds pursued Fothergill with all the ingenuity of a disappointed plaintiff, and for six months more continued his efforts to stir up Friends in his behalf. They still patiently heard all he had to say, and summoned Fothergill also once more before them, but the final minute of the Quarterly Meeting confirmed the report of a new committee, signed by fourteen Friends, stating their unanimous opinion that Leeds' fresh complaint was groundless and unjustified by evidence.

The support that Leeds found in this affair showed, much to Fothergill's surprise and grief, that there were a number of persons even in his own community ill disposed towards him. He was wounded in the house of his friends. Perhaps they had grown tired of hearing Aristides called the just. Moreover the habit of mind of a busy physician, quick in his work, and though gentle accustomed to be obeyed, did not always concihate opposition. It was, they complained, " the Will of the strong Man, armed with Affluence, Reputation and Power. Roc volo, sicjubeo, sit pro ratione voluntas." The trouble proved a bitter lesson to him, but perhaps a useful one, for he lived to overcome envy by patience, and to keep his temper unsoured. In the words of G. Thompson, " he rose superior to all discouragements, and persisted with unshaken resolution in the kindest acts of humanity."

As to poor Leeds, he kept an apothecary's shop in Bishops- gate for some time, and afterwards went to Ipswich, where he died in poverty in 1773. During his last illness his necessities

78 THE DISPUTE WITH DR. LEEDS chap, vm

were ministered to by an unknown hand ; it was whispered that it was the hand of FothergiU.^

Little need here be said of another matter, FothergiU's relations with the Parkinsons. He tried to act as peacemaker in a dispute between a young Friend, brother to Sydney Parkinson the explorer, and Mr., afterwards Sir Joseph Banks, in whose service the explorer had died. As is the fate of some peacemakers he turned the ire of the young disputant upon himself. Those who have the curiosity to read the story in the prefaces to Parkinson's Voyage can have no doubt of FothergiU's justice and generosity throughout.^

* See Elliot's Fothergill, p. x ; Works, iii. p. cxlvi ; MS. Minutes of Meetings concerned ; MS. Letters from and to Fothergill, Fds. Ref. Lib. ; [W. Smith, L. Weston & J. Sherwin] An Appeal to the Quakers on the late Difference, etc., 1773 ; Gent. Mag., 1773 ; 1781, pp. 165, 205 ; The Georgian Era, ii. 327 ; Dr. S. D. Clippingdale, in London Hosp. Gazette, No. 172, 1913, p. 183 ; B. W. Richardson, Disciples of Msculapius, ii. 444 ; Darlington, Bartram and Marshall, p. 507 ; Journ. Frds. Hist. Soc. iv. 109 ; Friends' Quarterly Examiner, xxxvi. 493 ; letter to the Author from Mr. John Millar, Univ. Edin. ; Thomson, Life of Cullen, i. 654-657 ; Hutchinson, Biographia Medica ; MS. Records & Recol- lections of James Jenkins, 1761 to 182 1, p. 167, Fds. Ref. Lib.

^ Journal of a Voyage to the South Seas in the " Endeavour," from the papers of the late Sydney Parkinson, draughtsman to Joseph Banks, Esq., 1773. Fothergill bought up the remainder of the edition for the benefit of the brother's destitute children, and circulated it, adding an explanatory preface of his own to clear himself from the unjust reflections conveyed in it. This brother was excitable and impracticable, and died in an asylum before the book was published. See also Fds. Quart. Exam., i8yy, p. gy. A letter from S. Parkinson to Fothergill, 1770, relating his circumnavigation of New Zealand, is in Frds. Ref. Lib.

BARON THOMAS DIMSDALE, M.D.

(1712-1800)

From a Mezzotint in the Friends' Reference Library, London

CHAPTER IX

BARON DIMSDALE— INOCULATION FOR SMALLPOX

The physician that bringeth love and charity to the sick, if he be good and kind and learned and skilful, none can be better than he. Love teacheth him everything, and will be the measure and rule of all the measures and rules of medicine. — Savonarola.

La Persecution aigrit les Esprits. La Liberte de Conscience au contraire amollit les Coeurs les plus endurees, ramene les opiniatres de rObstination la plus inveteree, et etoufie les Disputes si funeste a la tranquilMte de I'Etat, et si contraire a I'Union qui doit regner entre les Citoyens. — Tsarina Catherine II. of Russia, MS. Instructions, in Museum at St. Petersburg, 1787.

The practice of the inoculation of smallpox seems to have arisen in various countries at an uncertain period in the past.

It was long used in India, and was thence introduced into China. Some ages later, towards the end of the 17th century, history tells that it was brought to Constantinople from Greece. Meanwhile it existed already in other parts of the east, and in some European countries, for example in Wales and in Scotland ; but it was in the hands of old women and the wiseacres of the country-side, and had not come to the ears of the learned. Fothergill was the means of showing that inoculation had also long been practised among the negroes of the American colonies.^

There is then evidence of the discovery, made probably by accident, and it would appear independently in various lands, that smallpox could be artificially conveyed through a lesion of the skin to a healthy person ; that it there produced a much milder form of the disease, developing more quickly ^

^ Letter of Cadwallader Golden, 1752, communicated by Fothergill to the Medical Society (of Physicians), Med. Obs. & Inq. i. 227.

^ The patient sickened on the 8th, 9th or 10th day, instead of from the 13th to the 20th day (Dimsdale).

79

8o BARON DIMSDALE AND INOCULATION chap.

and very seldom fatal ; and that the inoculated person was then safe from future infection. It was called " buying " or, in China, " sowing " the smallpox, and children were often brought to a person sick of the disease for this purpose.

It is well known that Lady Mary Wortley-Montagu found the operation estabHshed in Turkey ; that her strong mind and practical instincts discerned its value, and that she had the courage to submit her only son, a boy of six years, for inoculation in 1717. It was introduced soon after this, partly by her efforts, into England ; was tried upon six criminals in Newgate under promise of pardon ; then upon a Quaker infant, Mary Batt, of Hertford, in 1721, the six domestic servants of the house taking the natural disease by caressing her ; and later upon many others, including the two young royal princesses in 1722. The practice reached America at the same period, commencing at Boston in 1721, through the efforts of Cotton Mather and Dr. Boylston. In Britain a storm of opposition, and a blast of pamphlets and sermons against this " dangerous and sinful practice," ^ checked its advance for a long time, but could not prevent its ultimate progress, and by the middle of the century through the advocacy of Mead and others the method had made much way on both sides of the Atlantic, although medical opinion was but half convinced.

In order to understand the case for this new practice, we must remember that the natural smallpox was in those days an extremely common and fatal disease, attacking all classes of society, and disfiguring those whom it did not slay. Queen Mary II. died of the complaint in 1694. The great bulk of the people had already suffered from it, so that its ravages at any given time were confined to the fraction which had not been attacked hitherto. One person, it was computed, died out of every five or six who sickened, and these deaths formed one-fourteenth part of the total deaths from all causes in the London bills of mortality.^ In the inoculated disease on the other hand the fataUties seldom exceeded even at this period one in a hundred cases. As time went on, advances were

^ The Rev. Mr. Massey, preaching at St. Andrew's, Holbom, on Sunday, July 8, 1722, declared that inoculation was first put in practice upon Job by the devil, who thus raised his blood to such a ferment as to throw out a con- fluence of inflammatory pustules all over him from head to foot.

* Dr. J. Jurin's statistics for the city of London for 42 years, 1667 to 1686, and 1701 to 1722. Letter to Dr. C. Cotesworth, London, 1723. Dimsdale in his Tracts on Inoculation, 1781, gives similar statistics for a later period of 34 years, showing that one-eighth of the totaj deaths occurring to those over two years of age were due to smallpox.

IX THE DIMSDALE FAMILY 8l

made in the mode of operation, especially by Dr. Kirkpatrick ; and Heberden exerted himself to make the best method well known. ^

But it was Daniel and Robert Sutton, the sons of a surgeon at Debenham, Suffolk, who during the years preceding 1765 so improved the practice of inoculation as to render it accept- able and popular. The operation was by this time overlaid with many accessories, preparatory and consequent — purges, emetics, bleedings, bhsters and anodynes — so that the process had become a very serious and costly one. Daniel Sutton had the sagacity to select those remedies and means which were really helpful ; and he set up as an empirical inoculator holding an infallible secret.^ People came to him in crowds, and his success was great. He published in his old age an account of his system : the chief points comprised the use of one puncture only, of spare diet, refrigerant drinks and cool air. The Suttons' ways were closely studied and adopted by another worker. Dr. Thomas Dimsdale, a friend of Fother- gill's, who became one of the leading inoculators in Europe. Before entering further into Dimsdale's work something must now be said of his origin and history.

Thomas Dimsdale came of an old medical family. His grandfather, Robert Dimsdale, surgeon, of Theydon Gernon in Essex and later of Bishop Stortford, was an early Quaker confessor and accompanied William Penn on a visit to America in 1684 : an oaken box curiously ornamented with his penknife on the long voyage is still preserved in the family. He printed in that year, " at the Sign of the Book and Three Blackbirds," a small pamphlet : " Advice how to use his medicines, which he chiefly designed for his old friends, who earnestly desired it of him before he left England."^ His son,

^ The Royal College of Physicians of London in 1754 declared the practice of inoculation to be " highly salutary to the human race." But even in 1769 an anonymous WTiter opposed inoculation as " perverting the order of nature [and] of the great Disposer of things, who has ordered every disease so as to be for the benefit of his creatures." See The Nature of Inoculation Explained.

* Daniel Sutton styled himself in 1769 " Professor of Inoculation in the kingdom of Great Britain, and in all the dominions of his Britannic Majesty." B. Dominiceti, Medical Anecdotes, 1781, p. 449 note.

' Joseph Smith, Catalogue of Friends' Books. Much search has failed to reveal a copy of this tract in any English or American library, public or private. R. Dimsdale was excommunicated in 1663 for practising physic without the Bishop's licence. He also lay long in Hertford gaol (about 1672) on a writ de excommunicato capiendo, i.e. arrested as an excommunicate for

82 BARON DIMSDALE AND INOCULATION chap.

John Dimsdale, married Susanna Bowyer and pursued the family calling at Theydon Gemon, where Thomas Dimsdale was born in 1712, in the same year as Fother- gill.^ Young Dimsdale acted as pupil to his father, who had " an extensive practice in physic," until the latter's death ; he then studied successively under Joshua Symonds and John Girle, surgeons at St. Thomas's Hospital ; quitting that school about the time that Fothergill entered it. He settled as a surgeon at Hert- ford, where the elder branch of the family had left a high medical reputation.

The year 1745 was a period of national alarm and distress : England was at war on the continent of Europe,

conscientious refusal to pay tithes. Besse, Sufferings, i. 250 ; W. Penn, Description of Pennsylvania, 1683. This Robert Dimsdale, who seems to have joined the Friends, had a father of the same name at Hoddesdon, and a brother, John Dimsdale, who settled at Hertford, where both he and his sons, Robert Dimsdale, M.D., and Sir John Dimsdale, M.D., were men of some note, holding the mayoral and other offices. This branch of the family became extinct. A certain William Dimsdale or Dimsdel of Ware was probably connected with the family ; a young man who forsook the Friends in 1673. See W. Haworth, The Quaker converted to Christianity, 1674.

^ Another son of Robert Dimsdale, William, was a surgeon at Bishop Stortford, and became the ancestor of the Dimsdales of Hitchin, Hertford, and Upton, some of them medical men and some bankers. Allied with this branch was the Cockfield family of Upton. It was through his valued friend and patient, Zachariah Cockfield, a Quaker shipowner, that Fothergill pur- chased his house and botanic garden at that place. Joseph Cockfield, son of the former and also a friend of Fothergill, was a writer, a man of scientific and antiquarian tastes, and a Friend of liberal views. "It is in the sphere of active life," J. Cockfield wrote about 1785, " that the true Christian must move. The solitary cell and the crucifix may suit a religious drone," but they ill accord with " the sweet and social principles of Christianity." Its votaries should be less anxious about meats and drinks and ritual observances, and should labour more to be useful to our fellow-creatures and innocent in life. J. Cockfield's daughter Sarah, who had been inoculated by Baron Dimsdale in her childhood, and had acted as T. Clarkson's amanuensis in his work for the abolition of slavery, married Joseph Dimsdale of Upton. She is remembered by some still Uving as a charming old lady, dwelling in a house full of ciuriosities in Bruce Grove, Tottenham : she died in i860. Her grandson was the late Sir Joseph Cockfield Dimsdale, Bart., P.C, M.P., Lord Mayor of London in 1901-2, and long Chamberlain of the city. Fothergill had a ward, Priscilla Pitts, left an orphan very yoimg, and placed under his guardian- ship by desire of her father, William Pitts of Southwark, a Quaker minister. She was " most wisely and tenderly cared for " by her guardian ; the poet John Scott was one of her admirers, but she married with Fothergill's full approval, in 1773, John Dimsdale, surgeon, of Hitchin, father to Joseph Dimsdale of Upton. E. G. Dimsdale, MS. Memoirs of the family ; Nichols, Lit. Illust. V. 753 ; John Scott, Poet. Works, 2nd ed. p. 200 ; Letter, J. F. to Dr. Ducarel, Gibson MSS. v. 225, Fds. Ref. Lib. ; Jos. Smith, Catal. Fds. Books, s.v. J. Cockfield.

IX FRIENDS AND THE REBELLION OF 1745 S3

and had to meet rebellion at home, the army of the Young Pretender penetrating as far as Derby. The people formed public associations for providing men, horses and arms, as well as large subscriptions of money to enable the government to meet the crisis. The ancient testimony of Friends forbade their being concerned in these warlike preparations, but some of them, moved with loyalty to the king and his cause, raised funds for a large supply of warm clothing for the soldiers, for it was in the depth of a severe winter.^ It is stated, on doubtful authority, that Fothergill, then a young man, took an active part in this work. In the Meeting for Sufferings he firmly upheld Friends' testimony against war, and was prime mover in the issuing of a paper very uncompromising in its tone. In the next year, 1746, after the rebellion had been quelled, the Meeting issued an Address to King George II., couched in language of fulsome congratulation on the result ; perhaps a solitary instance of such congratulation in the pubhc documents of Friends. The first draft of the paper was referred back to the Committee which had prepared it, and of which Fothergill was a member : on its revision it was passed unanimously. Later addresses to royalty, as in 1760 and 1775, in which Fothergill seems to have had a leading part, are of a different tenor.^

There was need, too, of surgical help for the soldiers, and Dimsdale, having lately lost his first wife, Mary

^ It is said that 10,000 woollen waistcoats, ample and double-breasted, were provided by the Friends in four or five days. See Gent. Mag. and Longstaffe, History of Darlington.

* MS. Minutes of Meeting for Sufferings, 1745 and 1746. R. M. Jones, Quakers in American Colonies, p. 360 ; M. E. Hirst, Frds. Quart. Exam., 1918, p. 300. The Address of 1746 has lately been reprinted. In a letter (16.4. 1746) to Eliza Bartlett, afterwards the wife of Henry Gurney, which is among the Dimsdale MSS., Fothergill, who had lately returned from Scarborough, writes of having passed Lord Lovat several times upon the road ; when that aged Highland rebel, sick in body but still stout of heart, was being carried up to London. At Leicester, his party lodged in the same house, " where," says Fothergill, " I found means of procuring Friend Barnard and her com- panion to be admitted into his room," doubtless on a religious visit. He was on his way to the Tower for trial and execution. The letter adds, "It is amazing how eager people are to see the shocking spectacle. Scaffolds and stands are erecting all about Tower Hill, and half a guinea per head given for places." To view it, he concludes, " I would not be hired."

84 BARON DIMSDALE AND INOCULATION chap.

Brassey, and being disengaged, offered his services free of charge as a surgeon to the army, and, these being accepted, continued in that office until the surrender of Carhsle. He was not now a member of the Friends. Dimsdale married again, in 1746, Anne lies, and with this lady, as well as by the decease of Sir John Dimsdale's widow, acquired a considerable fortune. Retiring from practice, he resided at the Priory, Hertford, a house built on the site of an old monastery, and here many sons and a daughter were born to him. The house is no longer standing, having been removed about 1906. The increase of family claims led him to resume medical work as' a physician, and to this end he graduated M.D. of King's College, Aberdeen, in 1761.

It was after this that Dimsdale turned his attention to the practice of inoculation for smallpox.

As has already been noted, the Suttons of Essex introduced about this time an improved method. This method was used, according to their own account, upon 17,000 persons, with only five or six deaths, and these not attributable to the opera- tion. Dimsdale studied their work, and devoted himself to the practice of inoculation both amongst the poor and the rich. His experience became very large and his success great. His methods, which were published in a series of papers, with a free acknowledgment that they were based upon the Suttonian practice, comprised the following measures. A fortnight's regimen in preparation was enjoined, in which no animal food was taken, nor fermented liquors, nor spices : a " preparitive " powder containing calomel, crabs' claws and tartar emetic (gr. I) was given occasionally, followed by a saHne. The matter for inoculation was often taken from another recently inoculated person at the point of insertion ; or similar dried matter was used. A minute incision ^ was made in the skin of the arm, seldom drawing blood, and was touched with the charged lancet ; this is contrasted with the large wound formerly inflicted, in which a string steeped in pus was laid, the wound sometimes sloughing in consequence. Dimsdale not infrequently operated on children in their sleep without awaking them. No dressing was applied. One or more of the powders and purging salts were given on subsequent days.

' Fothergill urged, as early as 1754, t^at the slightest scratch with the point of a needle was sufficient. Works, i. 226.

IX DIMSDALE'S SKILL AND REPUTATION 85

Moderate exercise was used, if possible in the fresh air, not shrinking from the cold ; and cold water was given to drink. In some cases even feverish patients were taken into the air, and this was done in all cases when the sweating had abated. The eruption was generally slight, consisting of not many spots, but sometimes it was abundant, with fever and distress, an event which could not, he says, be avoided. Precautions were taken against infecting others.

Under the care thus exercised, the results were excellent, and it is clear from Dimsdale's writings that the operation was brought in the hands of himself and others at that period to a high perfection. His first paper on inoculation was published in 1767 : it passed through seven editions, and was translated into varioms languages. In it he states that during many years' practice he had but one death after inoculation, and that attributable to other causes. Dimsdale was now much resorted to ; many people coming to Hertford to be inoculated under his care. There is no doubt that there was at this time something like a furore for the operation.^ The prize poem for the year 1772 at Oxford University celebrated its benefits. Pierced with deep anguish at the ravages of the monster smallpox. Lady M. Wortley-Montagu seeks a heaven-taught nymph. Inoculation —

Whose potent arm, with wondrous power endued. Had oft on Turkey's plains the Fiend subdued. Then fraught with mighty power her arm outspread. And thrice she waved it o'er the Monster's head : " By me protected shall they now deride Thy baffled fury and thy vanquished pride." ^

^ Charles Blackstone, brother of Sir William Blackstone the lawyer, writes from Winchester, January 24, 1767, to his friend Seymour Richmond of Sparsholt, Berks. His wife was resolved to make trial of the new method, and was going to Hertford for the purpose, with two maids, to a house ready furnished. He suggests that his friend should buy into the same lottery — " a lottery very different from our catch-penny state lotteries ! a lottery which (imder Providence) has had 9000 prizes and not one blank, oh, rare lottery ! " — cdluding to 9000 persons inoculated by the Suttons. A letter one month later reports his wife quite recovered, with only six pocks on her face. " Dr. Dimsdale has everything to recommend him as an operator, sagacity, tenderness, diligence, and genteel behavioiur." MS. Letters in possession of J. J. Green, Hastings, who has made collections on the Dimsdale family, pedigree, etc.

* " Beneficial Effects of Inoculation," by W. Lipscomb. Oxford Prize

86 BARON DIMSDALE AND INOCULATION chap.

There was ruling at this time in Russia the celebrated Empress Catherine II., sometimes called the Semiramis of the North. She had come to the throne without legal right after the assassination of her husband. Catherine was a person of masculine strength and abiUty and passionate nature ; of extraordinary dignity, and great personal charm. The infatuate libertinism of her private life cannot be condoned, though its enormity must be measured in relation to her age and country and the rank she occupied. This remarkable woman, the friend of Voltaire and the philosophes, led her people forward during the many years she reigned over Russia, in the ways of civilisation and of culture. Art and literature shone at her court. She had a zeal too for free institu- tions, and if she did nothing to liberate the serfs, at least she softened the cruelties of the penal code, and granted some toleration to the non-conforming churches.^

Amongst the benefits Catherine sought to bring into her land, was the use of inoculation to stay the ravages of smallpox, which was excessively fatal in Russia ; and in order to offer an example to the whole nation, she proposed to subject herself and her own family to the operation. The Russian minister in London, M. Pouschin, was ordered to make private enquiry for the best British operator : he was probably himself a patient of Fother- gill's, at any rate the latter's advice was sought. Fother-

Poems, ed. 1839, p. 15. His cousin, George Lipscomb, surgeon, was a stout champion of the method, even after Jenher had introduced vaccination. See his Manual of Inoculation, 1806, in which he quotes Dimsdcde ; and his Cowpox Exploded, 1806, etc.

^ Some one has drawn her portrait in lurid lines, hardly just to "its better features : " Take the map of the Empire of Russia for canvas, the darkness of ignorance for background, the spoils of Poland for drapery, human blood for colouring, the moniunents of her reign for the cartoon, and for the shadow six months of her son's reign." Waliszewski, The Romance of an Empress, trans. 1894, i. 290. On the other hand the traveller and artist, Charles Fox of Falmouth, visiting St. Petersburg towards the end of her reign in 1787, foimd displayed in a silver cabinet in the Museum Catherine's " Instructions," written in her own hand, for the formation of a new code of laws. In these she outlines liberal institutions for Russia ; " and though," C. Fox wTites, " the pride and selfishness of the nobles occasioned cabals, that would have rendered it extremely dangerous to attempt carrying the plan into execution at that time, yet it is to be hoped the season may arrive ... to break the shackles of feudal bondage." C. Fox, MS. Journal of Travels in Denmark, Norway, Sweden atvd Russia, 1787. See also at head of this chapter.

IX CATHERINE II. OF RUSSIA 87

gill, an early advocate of inoculation, had approved of his friend Dimsdale's method, and had advised him in his publications ; he now recommended his friend for the office : Dimsdale accordingly met M. Pouschin at Fothergill's house in Harpur Street. After some per- suasion from the latter, Dimsdale accepted the invitation made to him, that he should journey to St. Petersburg (Petrograd) for the purpose of inoculating the Empress and her son the Grand Duke. The minister asked him to name his own terms, but Dimsdale left this entirely to the Empress. Most people considered it a very hazardous enterprise, but he set off " with great cheerful- ness and gaiety," July 28, 1768, taking with him his son Nathaniel, who was then a student of physic at Edinburgh.

The journey was a long one, but ample and generous preparations were made by command of the Empress. After crossing to the Netherlands, they travelled rapidly, night and day, in a comfortable chaise, under the escort of a sergeant, " without feeling the least fatigue " ; and, including a few days' rest at Berlin, Dantzic and Riga, accomplished the journey from Amsterdam to St. Peters- burg in exactly one month.

Arrived at the capital they waited on Count Panin, the Prime Minister, who was very friendly. With him was Baron Cherkasoff, who had been educated at Cam- bridge and now presided at the College of Medicine in St. Petersburg. His friendship was throughout of great value to Dimsdale. These two men belonged to houses still famous in Russia. The Empress was herself away, but on her return to the court the visitors were introduced to her presence. A series of letters which Dimsdale wrote from St. Petersburg to an intimate friend in London, Henry Nicols, conveys to us the vivid impressions made upon his mind. " She is," he writes, " of all that ever I saw of the sex the most engaging : her affability and good sense are amazing." She has " a way of pleasing, without appearing to have an art." The Empress treated Dimsdale with great graciousness and confidence. As

88 BARON DIMSDALE AND INOCULATION chap.

the English doctor, so she told her nobles, had come without making any terms she considered him as a gentleman who paid her a visit, and he should have all the respect she could show him. A large house, sumptu- ously appointed, was set apart for him and his son, and was protected at his request by soldiery for the sake of secrecy and isolation ; a coach and four attended them all day. He dined sometimes at the Empress's private table, and had a general invitation to the Grand Duke's court at all hours and meals, " the oftener the better." The court was brilliant, the palaces magnificent : a great theatre was maintained in one of them at the imperial expense, free to the public, where French and Russian plays, music, masquerades, seemed to be without end. Amid these scenes Dimsdale and his son led an idle and luxurious life ; but all the time Dimsdale's mind was burdened by his errand : " Many corroding cares disturb me, and embitter all this greatness which I am not able to enjoy."

At a second private interview the Empress, he writes, " told me her resolution was taken to be inoculated, but enjoined the most perfect secrecy. I besought her to let me have the assistance of the physicians, to whom I should communicate my whole plan. Her answer was : * I know my own constitution very well, and will answer any questions, but have taken a resolution to repose the most absolute confidence in you alone, and insist on no persons being acquainted with my design.' I bowed and promised obedience, but with great anxiety." Just then it came to his ears that some one of repute had said that he wished the English doctor success : that he had a good deal of spirit, but that if he undertook to inoculate either the Empress or the Grand Duke it was more than any man that knew Russia would do. He had indeed a perilous task. Had either case proved fatal Dimsdale's life would have been threatened. Tradition relates that the Empress had arranged for a service of fleet post- horses to convey the doctor out of the kingdom in such an event.

IX A GUEST AT THE RUSSIAN COURT 8g

Dimsdale now proceeded to some preliminary opera- tions. His son inoculated two cadets aged about four- teen years, taking the matter from a poor man's child, which was sick of smallpox and afterwards died. One of the cadets fell ill of fever and vomiting on the second day ; and continued to lie in a serious condition. Dims- dale deemed that this trouble was foreign to the inocula- tion, and said so, ascribing it to a surfeit of fruits, but under the circumstances it was not a little disquieting. The Empress had reports of the case twice daily. " I saw her," he writes, " when things were at the worst. She said : ' I will not have you look dull and unhappy, I shall take your word for it, and you shall inoculate me whenever you think proper : I even long for the happy day.' This was indeed a cordial." The boy lost his fever, and both subjects had the disease but slightly. Dimsdale then inoculated five others with matter from another patient.^ Strange to say, the usual signs failed to develop in all these cases, but an inflamed pustule appeared at the point of insertion. This event per- plexed him greatly ; it had never happened to him before, nor did it afterwards. Had he only known it, Dimsdale was here on the verge of a discovery. The virus of the disease had become in some way attenuated, and the resulting disorder was closely akin to vaccinia. Dr. Joseph Adams had a like experience in 1805 : from a case of natural smallpox which had been inoculated in the interval between infection and outbreak, he cultivated a strain of virus which produced only local pustules, like those of vaccinia, and he continued the strain through eight series of cases.

After consideration Dimsdale came to the conclusion that these five persons must have passed through the natural smallpox at some early period of their lives. He desired they might all be inoculated again, in the old manner, with a long incision, and gave his opinion that

^ The case was one of natural smallpox ; the eruption was full, but favour- able and distinct, and the pocks near the time of maturation ; the patient was shut up in a room with a foul atmosphere, but recovered nevertheless.

90 BARON DIMSDALE AND INOCULATION chap.

they would not be susceptible. The Empress approved : it was done ; and not the least symptom followed. They were as Dimsdale thought protected, but it was in truth by vaccination.

He then inoculated three healthy children, to provide matter for operating on the Empress. A message reached him from the latter desiring him to fix a time, and to bring one of these boys secretly to the palace in the night, where he would find her prepared. " I could scarcely believe my eyes," he writes, " for it seemed absolutely improbable that her resolution would continue. How- ever, in obedience to her commands, at nine o'clock on Sunday, Oct. 12th, I was carried in a coach, taking the selected child ^ wrapt in a pelisse with us, to a gate of the palace ; and was met by Baron Cherkasoff, who alone was entrusted with the secret, and conducted by back stairs to a Uttle room where her Majesty waited. Here she was inoculated alone, with one puncture on each arm. All this being done in the night, no one knew of it, and I returned to my lodgings ; but next morning privately slipped into one of her Majesty's coaches, and with eight horses and three postillions was brought hither (Czarscoe Selo) where her Majesty had arrived a few hours before. A pretence had been found for her going to this palace, and the inoculation was not known till the fifth day. She has had the smallpox in the most desirable manner : a moderate number of pustules, and complete maturation, which now, thank God, is over, and I find an inexpressible load of concern removed from my breast."

Dimsdale wrote an account of the Empress's case. He gave her his mercurial powder on the fifth day, followed by a dose of Glauber's salt, which was repeated twice in convalescence. He had brought some of his powder with him from England, but proposed to give her some prepared by her own chemists. Her Majesty

^ It is said that the boy, Markoff, was ennobled for his share in the operation, receiving the surname Ospiennyi, ospa signifying smallpox ; the family now occupies a high position in the country. Waliszewski, op. cit. i, 283.

IX HE OPERATES ON THE EMPRESS 91

said, " Let me take your own : I prefer it to any other " ; does it not tell, he adds, a little romantic ? The patient did not, it appears, stay in bed, although feverish on the seventh, eighth and ninth days. She walked every day in the open air from two to three hours, until the eruption appeared, which was nearly coincident with the fever. She had a sore throat from the twelfth to the fourteenth day : she took solid food almost throughout, and returned well to St. Petersburg on the twenty-first day.

The Grand Duke underwent Ms operation on 2nd November. This was again an anxious proceeding, as the boy, about fourteen years old, was of a tender and delicate habit, and had had trouble in his glands and throat. He had been brought up by his great-aunt, the Empress Elizabeth, in the most injudicious and extraordinary manner. Dimsdale requested his two medical attendants to assist, but they declined the responsibility, as did a third ; they put, however, every information at his dis- posal. A careful regimen of restricted diet, fresh air, mild purgatives and bark, was carried out for some time beforehand. The inoculation was made by a sHght puncture, no dressing was used, and the patient walked out daily, even when feverish ; only on one day he lay down for a while. There was considerable sore throat, but he had the disorder very favourably : four pocks on the face, and from twenty to forty elsewhere.

Universal joy prevailed at these results ; for the Russian nation in general adored the Empress and the Grand Duke. The compliment and privilege Dimsdale received were enough, he said, to make him distracted. " I thank God," he writes, " that I have sense enough to know that my consequence is like the fly on the chariot wheel. Everyone is mad to be inoculated. It will be impossible for me to avoid more business than I can execute properly. Our patients consist of the first nobility. I have been slaving all day : all the patients go on well. I have been told by Count Panin (who could not show me more kindness if he was my own brother) that another honour remains for me — eclatant was the

92 BARON DIMSDALE AND INOCULATION chap.

word. I am to inoculate one of the archbishops. I dare say this is intended to strike at the root of all re- ligious scruples." Altogether Dimsdale inoculated about 140 persons at the capital, and all did perfectly well.

Nothing had as yet been said as to Dimsdale 's reward. His friend Dr. Ingenhaus, who had inoculated the imperial family at Vienna, had just been appointed councillor and chief physician, with a pension for himself and his wife, besides large presents and court privileges. About the middle of November, Dimsdale received a message from the Empress, that she had the highest sense of his services, and was desirous that the name of Dimsdale might be honoured as long as Russia existed, and with that purpose had determined to create him a Baron of the Empire.^ The public declaration of his nobility was made on a day appointed for Thanksgiving, in the presence of a court brilliant beyond expression. The new Baron kissed the Empress's hand, receiving from her at the same time a present of £10,000 and miniatures of the Empress and Grand Duke, He was appointed physician to her Majesty and conseiller de I'^tat, with the rank of major-general and an annuity of £500. ^ The dignity of Baron was also

^ The following is taken from a copy of the patent of nobility, translated : " We Catherine the Second by the Grace of God Empress and Autocratrix of all the Russias . . . make known [that] in justice to the rare merit of Thomas Dimsdale English Gentleman and Doctor of Physic whose virtue and laudable concern for the good of mankind . . . induced him ... to apply all his . . . faculties towards improving the inoculation of the smallpox, as the only rational preservative of the human species against that mortal disease, and . . . [who] has raised this practice to such a degree of perfection, as that all the apprehensions of danger from the smallpox in the natural way may be . . . dispelled ; who, regardless of his private Interest, and intent only upon accelerating human Happiness, did not hesitate to lay open to the World his Discoveries ; who . . . refused not on our invitation to leave his Family and to visit our Court, purely to render Us all the services in his Power, . . . and who at last did with remarkable Care Skill and Success actually inoculate as well Us Ourselves and Our beloved Son the Czarowitz and Grand Duke, as also many inhabitants of Our Capital, and who thus removing the anxious Fears of our Faithful Subjects destroyed at the same time that baleful Hydra Prejudice, and the dreadful apprehensions of this (hitherto) fatal disease. We have been pleased to testify to the said Thomas Dimsdale our grace and favour, by such . . . marks of distinction as shall not only tend to his . . . Honour for ever, but may also excite his Posterity and other Learned Men, . . . to pursue such studies and Investigations of Nature as may prove equally beneficial to the human Species."

* He received also from an old Comit, whose children his son had inoculated, a parcel of £500 in gold coin, with which, he says, he went limping out of the hous ..

K CREATED A BARON OF THE EMPIRE 93

conferred upon Nathaniel Dimsdale. A few days l^er Dimsdale was invited to a shooting excursion in the country with the Empress and four of her noblemen. The day was spent, he says, most enchantingly, " her Majesty shot nine moorfowl and I shot four." On these occasions, he adds, the Empress commands all ceremony to be laid aside, and it pleases her to forget her greatness.

At a later date Dimsdale and his son set out for Moscow, having inoculated a little girl whom they took with them to furnish material. Owing to delays on the bad roads — they were following the army marching against the Turks — the eruption came out before they arrived at the city, where, however, they successfully inoculated upwards of fifty patients. Whilst at Moscow Dimsdale suffered from a severe pleuritic fever, but at the end of two months' stay he returned to St. Petersburg by sledge. Here he had to attend the Empress in a similar disorder ; taking personal charge of her case, and undergoing, he states, great anxiety on her behalf ; he bled her to eight ounces, the imperial surgeon having refused to do so. Happily she recovered, and at length Dimsdale and his son were able to take their leave, and to return, laden with gifts and honours, by the same comfortable mode of travel, to their own land. En route they paid a visit to Sans Souci, Potsdam, where they were graciously received by the King of Prussia, Frederick the Great.

Dimsdale returned home in 1769, and in the same year he was elected a Fellow of the Royal Society. He con- tinued to practise inoculation at Hertford, where he opened an inoculation house ^ which was much resorted to, and in 1774 he gave this treatment by the command of the king to Omiah, a native chief brought from Tahiti by Captain Cook. In 1778 he was engaged in a contro- versy with Dr. Lettsom, who promoted a Dispensary for

1 A small isolated house, now called the Stant Farm, and near to the Hertford Gas-works, has been long known by tradition as once a receiving house for sick persons, and was probably Dimsdale's Inoculation House. It originally belonged to the same manor as the Priory. William and Samuel Graveson of Hertford, and R. T. Andrews, Hon. Treas. East Herts Archaeo- logical Society, have kindly afforded local information on Dimsdale.

94 BARON DIMSDALE AND INOCULATION chap.

General Inoculation. The purpose of this institution was to inoculate the poor at their own homes. Dimsdale opposed the plan, on the ground that infection would be spread in the crowded houses and narrow courts where the children played together ; the operation was, he said, much better and more favourably done in the Inoculation Hospital — an airy house, standing in four acres of ground. The controversy soon degenerated into a personal one, pamphlet reply being quickly followed by rejoinder, and if it was Dimsdale who first took up the contentious pen, that of the younger doctor was dipped in the bitterer gall. Perhaps the dignity of the Baron led him to pose as an authority — " the Great Inoculator," as Lettsom styled him, " who claimed an exclusive right to the theory and practice of inoculation." On the other hand, the wounded vanity of his antagonist caused him to heap unmeasured satire and reproach upon his former friend. Fothergill tried in vain to dissuade them from the unworthy contest, derogatory he thought to the honour of their profession. Dimsdale comes out the better of the two from the encounter, and their strife does not seem to have led to a permanent estrangement, Lettsom in after years writing Dimsdale 's biography for the Gentleman's Magazine.^

A second visit was paid to Russia in 1781, in order to inoculate the two sons of the Grand Duke, Prince Alexander, afterwards well known as Czar during the Napoleonic era, and his brother Constantine.^ A diary of this visit was written by the Baron's third wife, who accompanied him. The volume, elegantly bound, is still preserved in the family ; it is adorned with a fine portrait of the Empress, illustrations of buildings, etc. The visitors were received, we are told, with much state and also great cordiality.^ It is said that the Baroness

^ See the various pamphlets by Dimsdale and Lettsom on Inoculation, printed in 1778 and 1779.

* The Czar Nicholas I., who died at the outset of the Crimean War, was a much younger brother.

^ The Empress wrote to Dimsdale, Sept. 25, 1781 : " Le papier que M. le Baron Dimsdale m'a remit hier, je le regarde cofiie vme nouvelle preuve du meme zele et attachement pour ma personne et ma famille qu'il n'a cess6

IX HIS LATER LIFE AND CHARACTER 95

nursed the young princes until their recovery, and that they called her their English mamma. On the way home a visit was paid to the Emperor Joseph II. at Vienna.

After his first visit to Russia Dimsdale entered on banking in London in conjunction with his sons, founding the well-known house which stiU bears his name. In 1784, having decUned all medical practice except for the relief of the poor, he was returned to parliament as Tory member for Hertford, retiring in 1790 in favour of his son Baron Nathaniel. After passing some winters at Bath, he died at Hertford in 1800, at the age of eighty- eight year€. He was buried, by his own request, in the Friends' ground at Bishop Stortford, though he had long ceased to be a member of that Society, having been " disowned " in 1741 for " marrying out " ; yet he styled himself in 1796 a " zealous Friend." About seventeen years before his death he was operated on by Wenzel for cataract and his sight restored.

Baron Dimsdale was a practitioner of high abihty, and seems to have cultivated medicine in a scientific spirit. As a man, he was kindly and philanthropic : a gentleman, urbane and tactful, his tranquil disposition carried him through many varied experiences to extreme old age. A fine miniature of Dimsdale was painted by Andrew Plimer in 1790, but was unfortunately stolen from the National Portrait Gallery, London, in 1904, and never recovered.^ He printed privately in 1783 a Tribute, appreciative if inaccurate in detail, to the

de me temoigner depuis que j'ai le satisfaction de la conoitre, aussi peut 11 etre assure de ma tres sincere seconnoissance. Je n'oublierai jamais qu'il a delivre du fleau de la petite verole naturelle moi, mon fils, et mes petits fils." He brought from Russia miniature portraits and other tokens, including two coats that belonged to Catherine's grandchildren, profusely ornamented with gold, etc. ; these are still treasured in the family. The Baroness, who long survived her husband, living on, crippled by rheumatism, at Hertford, used to tell anecdotes of her imperial chcurges. One day, Alexander, aged about six years, *' feeling ill, ordered his attendant to go and fetch his purse. This being done, he took out two pieces of money, told the Baroness he should die, and gave them to her to keep for his sake." The other boy, more boisterous in disposition, followed suit. MS. Journal of Margaret Woods, Fds. Ref. Lib. ^ A good copy of this miniature by Henry Bone is in the hands of the family, and a photograph is at the Gallery, besides engraved portraits.

96 BARON DIMSDALE AND INOCULATION chap.

Memory of Fothergill, his " friend and adviser for more than forty years." It appears that the latter had at one time thought that a son of Dimsdale might succeed to his practice.^

The practice of inoculation was continued to the close of the eighteenth century. Dr. John Haygarth indeed formed a plan for exterminating smallpox by its means from Great Britain. He first carried it out with much success in his own city of Chester. In 1778 he laid his more extensive scheme before Fothergill, and the latter brought it to the notice of his medical friends. It had however but a mixed reception, varying " in proportion to their humanity." The mode of infection was at that time often in dispute. Fothergill used to teU the story of a medical wig which conveyed the disease from London to Plymouth. His relative Waterhouse capped the tale with Uke incidents that had come to his own knowledge ; one doctor, after visiting a smallpox hospital, " neglected to smoke his wig," and conveyed the disease in consequence to his daughter. Haygarth on the contrary maintained that the infection was only aerial. ^

•Inoculation was at length superseded by vaccination, for which it had in truth paved the way. Jenner pubHshed his work on the VariolcB Vaccinice in 1798, and five years later the Royal Jennerian Institution was founded, and the new practice came into large employ. Inoculation, however, was stiU used by many for a long time ; and in some countries, for example Persia, it is practised at this day ; but in England it fell under general condemnation, and in 1840 was prohibited by the first Vaccination Act as a felony.

It was considered, in the first place, that inoculation tended to spread the disccise, although in a milder form. This seems to have been true, for the necessity of isolation

^ On Dimsdale see, besides the references in the Diet. Nat. Biog., Biographical Catalogue of the Friends' Institute, London ; Soc. Frds. MS. Registers ; L. Tumor, Hist. Hertford ; Berry, Herts Pedigrees ; Extracts and MSS. in Frds. Ref. Lib. ; Eliz. G. Dimsdale, MS. Memoirs of the Family. The account of the first visit to Russia is chiefly taken from MS. letters to H. Nicols, and other papers in the possession of Dowager Lady Dimsdale, who has most kindly allowed the author to make use of them. A description of Dimsdale's visits to Russia is given in E. A. B. Hodgett's Life of Catherine the Great, 19 14, c. xvi., based upon a French MS. preserved in the Imperial Archives in Peters- burg. This is evidently for the most part a translation of Dimsdale's narrative in his Tracts. Several books and tracts on Inoculation were published by Dimsdale at Petersburg in 1770. See his Thoughts on Inoculations, London, 1776, and Tracts on Inoculation, 1781 ; Gent. Mag., 1801, i. 88, 209, ii. 669.

2 Haygarth, Sketch of a Plan to Exterminate the Casual Small Pox, 1793, pp. I, 265, 320.

I

IX ATTENUATED FORMS OF SMALLPOX 97

was not then fully understood, in spite of the enlightened practice of Hay garth, and of Waterhouse and others in America. The deaths from smallpox in London actually continued to increase and attained a maximum after the introduction of inoculation. But towards the end of the century the mortahty decUned, and was sensibly less before vaccination was introduced. After the latter event the fall in the death-rate was rapid, and in our own time although it stni fluctuates it has nearly reached zero. The general improvement of health from other causes must of course be taken into account.

It was further objected that many of the inoculated cases were severe and some fatal, and lastly that the operation was not invariably protective. It must however be borne in mind that the experience of Dimsdale, Adams and others shows that the risk could be reduced with due care and skill almost to vanishing point, and that there is no such thing as absolute protection ; which is conferred neither by vaccination nor by any other prophylactic method, nor even by a previous attack of the disease. Upon the whole Sir Thomas Watson's opinion seems to be justified, that the advantage derived by the individual from inoculation was counterbalanced by the increased risk to the community.

Inoculated smallpox and vaccinia appear to be essentially modifications of smallpox, altered by transmission through man or animals. Dr. Copeman has indeed demonstrated by experiment the intimate relationship of the three disorders, which he thinks are probably descended from one common stock. The mild inoculated disease has become attenuated in passing through the human system by the way of inocula- tion. In this process the virus is introduced amongst the epithelial cells of the tissues, where it sets up a free local growth ; and it appears, according to our present knowledge, that the spores or parasites lose certain of their properties when they enter the system in this way. When smallpox is acquired in the ordinary manner, presumably by the air-borne parasites entering the air passages, those which succeed in overcoming the leucocytes and entering the tissues produce the more severe disorder. The attenuation of the virus in inoculated smallpox may also be due in part to a higher degree of immunity present in the subject in whom the inoculation is made ; for it may be assumed that the average immunity of those inoculated is higher than that present in a person taking smallpox in the ordinary way. Vaccinia is probably derived from the mild inoculated disease, further

H

98 BARON DIMSDALE AND INOCULATION ch. ix

modified by repeated transmission through the bovine animal. It then ceases to produce a general eruption, or to be infectious in the ordinary manner, whilst still protective against the major disorder. Dr. W. T. Councilman of Harvard University has found certain minute bodies (cyto-ryctes) in the cells of the tissues, having two forms : the one form (probably asexual) is found in the protoplasm of the cell in cases of vaccinia : the other form (probably sexual and rapidly multiply- ing) is found within the cell-nucleus in the acute disease. The Hfe-history of the parasite depends upon its host : in the calf or rabbit it follows the milder cycle only, and vaccinia is the result : in man or monkey it goes on to the more active cycle, and variola is developed, although in the case of the monkey only the sHghtei* (inoculated) form occurs. The doctrine of the attenuation of a disease virus by passage through a Uving animal, which was founded by Pasteur and others upon Jenner's original suggestion, has come to include other diseases besides smallpox, especially rabies, typhoid fever, cholera and plague ; and the prophylactic measures thus derived hold the field, in the present state of our know- ledge, as the best means of defence against these scourges of the human race.^

^ Authorities : Woodville, History of Inoculation, 1796 ; see also Phil. Trans. Iviii. 140 and elsewhere ; S. Miller, Retrospect of the Eighteenth Century, p. 1354 ; Jas. Moore, History of Smallpox, 1815 ; Jos. Adams, Answers to Objections to Cowpox, 2nd ed. 1805 ; also his Account of the Hospital for Small- pox, Inoculation and Vaccination, 3rd ed. 1817 : he gives the mortality of inoculated cases as follows: In-patients (9 years), m/; Out-patients (6 years), I in 1000 (p. 27) : his strain of mild inoculated smallpox is recorded on pp. 11, 12 ; Dr. E. M. Crookshank, History and Pathology of Vaccination, 1889, i. ; W. Farr, Vital Statistics, pp. 304, 305 ; Sir T. Watson, Lectures, 1848, ii. ; Dr. S. M. Copeman, Natural History of Vaccination, Milroy Lectures, 1899, and Modern Methods of Vaccination, 1903 ; also article in Allbutt's System of Medicine, 2nd ed. II. i. 746 ; Dr. F. M. Sandwith, Clin. Journ. Land, xxxvi. 317-329 ; Dr. W. T. Coimcilman, Journ. Med. Research, Boston, xi., Feb. 1904 ; also in Osier and McCrae, System of Medicine, ii. 254, etc. ; Drs. W. G. Armstrong, J. B. Cleland and E. W. Ferguson, of Sydney, N.S.W., Proc. Roy. Soc. Med. Epidem. Sect., Nov. 1914, where an epidemic disease is described, said to be a mild type of smallpox, occupying a half-way house between it and vaccinia ; in one case parasites in the cell protoplasm were foimd. Was this identical with " inoculated smallpox " ? In view of Dr. Copeman's researches on a similar epidemic at Cambridge in 1903, was not the attenuation of the disease due to bovine transmission ? It seems to have been brought by men working on cattle-boats.

Cv)

/J;

. I/u/ru,.- //i/?/i//// / (rr/ir/-/,

CHAPTER X

DR. LETTSOM

Enthusiasm has its place, not only in action, but in writing ; quite as much as critical analysis and judicial impartiality have theirs. — Admiral Mahan.

At this time there seems to be a spirit pervading Europe, equally novel in its nature and effects : princes begin to view men as beings like unto themselves, and people to feel their own importance, and that freedom and independence are the true springs of industry and happiness. May these sentiments, which have sprung from the American revolution, continue to inspire princes and subjects, until at length that perfection of government be estabUshed under which the happiness of the ruler and the ruled are synonymous. — Dr. Lettsom to Franklin, 1785.

Dr. John Coakley Lettsom was the biographer of Fothergill, who was his patron and friend. Like Fother- gill, he was a Quaker physician of large practice in the metropoHs, distinguished for scientific tastes and for philanthropy.

Lettsom was born in 1744 in the island of Little Vandyke in the West Indies. His father, Edward Lettsom, a Friend, owned the islet, and raised cotton by the labour of fifty slaves, whose cottages stood upon a hill-side near his house. He had also a sugar plantation on the adjacent island of Tortola. The mother of Lettsom bore, so it is said, seven pairs of twin children, all males ; Lettsom and his brother Edward were the last, and the only survivors. His father's family came from Letsom ^ in Cheshire, and his mother was descended from the Coakleys, baronets in Ireland. Being sent to England

^ Perhaps Ledsham, a village six miles north-west of Chester. Mr. John H. Cooke of Winsford, author of " Bibliotheca Cestriensis," has kindly furnished the author with information.

99

100 DR. LETTSOM chap.

to the Rawlinsons, Friends at Lancaster, at the age of six years, in order to his education, the boy met Samuel Fothergill, and by his advice entered the Friends' School at Penketh. Here he engaged heartily in country pur- suits. Young Lettsom's father dying, S. Fothergill became one of his guardians, and he was placed by the latter in 1761 with a well-trained apothecary, Abraham Sutcliff, of Settle, a man of high repute in that district. Under his supervision Lettsom acquired the medical art, besides giving attention to botany and the Latin and French languages. Lettsom never forgot what he owed to his old master, and procured for him many years later a Doctor's diploma, that he might retire to a less arduous kind of practice.

Leaving Settle, Lettsom went up to London with an introduction to Dr. Fothergill, who became his warm and steady patron. He took one year's course at St. Thomas's Hospital, where he entered under Benjamin Cowell. He worked early and late, examining patients, reading up his cases and taking notes. One of the physicians to the hospital was Akenside, a haughty figure in his white wig and long sword ; his harsh manners to his poor patients repelled Lettsom's kindly heart. After this, in 1767, Lettsom returned to Tortola to take possession of what was left of his family property ; this consisted chiefly of negro slaves, to whom he gave their liberty, leaving himself almost penniless. " I could no longer withhold from them," he says, " the natural privilege of freedom, which Heaven had conferred upon me. I never repented, ' ' he adds, " this sacrifice ; indeed Heaven has cancelled it long ago, by refunding innumerable unmerited blessings, and what I estimate still more gratefully, a heart to diffuse them." This was at a period when many even of the Friends were not yet convinced of the evil of slavery. His freed negroes sometimes sent to him in after years some little present, a coral or a shell. In 1784 he received a pot of sweetmeats from Teresa, a beautiful mulatto.^

* J. J. Green possesses the original Deed of Sale, dated July lo, 1768, from Samuel Taine of Tortola, cooper, to J. C. Lettsom, M.D., for £200

X LIBERATION OF HIS SLAVES loi

He was touched by the attention : " Thy master," he soliloquises, " will probably never see thee in this world ; in the next thou mayest appear white as a European." In later life Lettsom advocated gradual emancipation.

In Tortola he entered into medical practice, for which the young man showed so much aptitude as to attract crowds of patients ; he would prescribe for fifty or one hundred of these before breakfast ; and he acquired in the space of five months nearly £2000. One half of this sum he gave to his mother, and with the rest set out again for Europe, determined to follow the example of Fother- gill as a physician in London. Landing in England in 1768 he took under the latter's advice a further course of medical training, studying at Edinburgh under Cullen, and at Paris, where he was introduced by Franklin to Dubourg. He heard Albinus and Gaubius at Leyden, and graduated M.D. there in 1769, with a thesis on the medical qualities of tea. Fothergill, who was a shrewd judge of character, perceived his talents, and wrote to W. Logan ^ that he was likely to make a considerable figure in the metropohs.

After some further travel, Lettsom began practice as a physician in the City of London, much aided by the advice and countenance of Fothergill, who had lately removed to the west. Fothergill's niece, who met him often at her uncle's house, where he breakfasted almost weekly, has much to say of the foibles of the young doctor, to whom nevertheless she was indebted for many a pleasant escort to visit objects of interest in the town. His flow of conversation, his frequent confidences and gallant trifling, seemed to her Friendly mind extra- ordinary. The " volatile Creole," as he once styled himself, was, however, soon adapted to English life, and fixing his affections on Ann Miers, the daughter of a

current, of " a Molater Boy named Sam and a Molater girl named Teresa " — with their reversion, profits, issue and increase, for ever. Lettsom may have bought them for his mother before he left the island, perhaps setting them free on purchase.

^ MS. Letter, May 8, 1769, Coll. Phys. Philadelphia. Fothergill also wrote a letter in 1768 recommending him to Friends in Edinburgh as having " acquired a just degree of esteem " [Journ. Fds. Hist. Soc. ix. 123).

102 DR. LETTSOM chap.

wealthy tin-plate merchant in the city, a Quaker like himself, he married her in July 1770. His wife, to whom he was ever kind and attentive, survived her husband.

Meanwhile he was constantly pursuing medical and scientific studies. Although his type of . mind was not that of the patient student, he had an uncommon power of work, and great readiness in the use and display of his knowledge ; whilst his easy and familiar manners — Fothergill was rather " perpendicular " for his taste — made him many friends. He obtained the licence of the College of Physicians in 1770, and was elected a Fellow of the Society of Antiquaries in the same year.

Lettsom lived in Sambrook Court (now the Wool Exchange), Basinghall Street, hard by the Guildhall of the City of London. The house has long since gone. There for many years he carried on the largest medical practice in the city. The death of his patron, Fothergill, in 1780, and that of Dr. Thomas Knowles, another Quaker physician, in 1786, much increased his work. Quick of perception, ready and resourceful, and full of the bon- homie of hfe, Lettsom acquired a repute which his medical attainments alone would hardly have given him. " I live with my patients," he said, " in the most frank sociaHty." He had, too, a sincere sympathy with the suffering. He held no hospital appointments, but was physician to the General Dispensary in Aldersgate Street, which he helped to found in 1770 ; it became the parent of many like institutions.

In 1772 Lettsom published a small work on Fevers, a subject which interested him all his life.^ In his " Medical Memoirs of the General Dispensary," 1774, he attributes fevers to a specific human contagion rather than to miasmata and other reputed causes. His treatment of these disorders was ever marked by courage and good

1 Reflections on the General Treatment and Cure of Fevers, 1 772 . an anonymous work, based upon authorities, ancient and modem, including CuUen, to whom he refers. Lettsom does not therefore seem open to the charge, which has been brought against him, of using Cullen's views without due acknowledg- ment. His own practice in the West Indies had afforded him experience in this department of medicine.

X HIS EARLY ACTIVITIES IN LONDON 103

sense ; he used the bark freely, and cold fresh air of the dawn — aurora salutifera.

He took the leading part in 1773 in founding a medical society on a new and representative basis, since well known as the Medical Society of London. In its interests he worked assiduously through good and ill fortune, sparing neither his time nor his money ; his name is perpetuated in the annual Lettsomian lectures. The establishment of this society is Lettsom's chief title to honour in his own profession, and it will be more fully dealt with in another chapter. Before the society he read many papers on medical topics, some of which were published, including an oration on the History of Medicine (1778) . In a paper on Hard Drinking, published later in life, he traces the various effects of alcohol with much acumen, distinguishing several types of cases. He deals especially with the effects upon women, and describes the symptoms which are now known to be due to peripheral neuritis — the wasted paretic lower limbs, the smooth shining skin of the soles, which are exquisitely tender, and the involuntary spasms and cramps.^ Lettsom read a paper before the Royal Society in 1786 on a case of intussusception in a child of four years. He wrote much also, as we shall see, upon inoculation for smallpox and on vaccination. But he put forth no work of outstanding importance ; his genius was too discursive in its range. He was a practical physician and had a happy way of treating patients. Some of his prescriptions have come down to us.^

^ Hints respecting the Effects of Hard Drinking, 1798. He tells of a man who cured himself of drinking by dropping daily a little sealing-wax into his dram- glass imtil in course of time it was filled. He concludes with a " Moral and Physical Thermometer " or Scale of Temperance, an idea derived from Dr. Rush. Water stands at the head, and small beer a little below ; these produce health, wealth and happiness. Cider, wine, p)orter and strong beer are set lower down ; they still promote cheerfulness and strength, when taken moderately and only at meals. All stronger liquors are placed below zero point. These are punch, toddy and grog, " flip " and " shrub," and " hysteric water." Still lower come morning drams of gin and whisky ; and, worst of all, those taken in the night. All these lead to many vices, ranging from idleness to murder, to a long list of diseases, and to penalties, which begin at debt, and end in the hulks, Botany Bay and the gallows.

* Thus in rheumatism, he used Tinct. Guaiac. with honey and Aq. Camph., and in the acute disease, Ipecac, Antim. Tart, and Aq. Menth. Vir. In dropsy

104 I^R- LETTSOM chap.

The scientific pursuits of Lettsom were also varied. As early as the year 1773 he was elected a Fellow of the Royal Society. He followed Fothergill in his interest in botany, and brought out the " Naturalist's and Traveller's Companion " in 1774 — a book containing instructions for preserving plants and other objects of natural history. In his garden at Camberwell he cultivated rare plants and trees, and he took thither the chief contents of Fothergill's greenhouses after the latter's death.

In 1786 he had a collector searching North America for plants and ores. He was a liberal supporter of his friend WilUam Curtis, the apothecary and botanist, helping him freely with money in the issuing of his Flora Londinensis, and the second volume of that magnificent work was dedicated to Lettsom, " the friend of humanity, the patron of science." Curtis had a Botanic Garden and Library in Higler's Lane, Lambeth Marsh. A genus of convolvulaceous plants was named after Lettsom by Roxburgh in 1814.^ His interest in minerals led him in 1784 and later years to send out to Professor Waterhouse more than seven hundred specimens of metallic ores, crystals, etc., for the use of the students in the Cambridge University, New England. The collection was the finest of the kind in the United States ; it was catalogued and kept in a spacious room devoted to the purpose.^

he gave Pot. Super-[Acid] tartrai. with Inf. Junip. He treated fli*or albus with turpentine, rhubarb and extract of hop. For dyspepsia, chalk and magnesia, with cardamoms and infusions of clove and quassia ; or rhubarb, Pot. Sulph., Syr. Papav. and peppermint. Amongst laxatives, he used senna, jalap and Magn. Sulph., made up with tamarind infusion. [Nesbitt], Memoirs of Physicians and Surgeons, 2nd ed. 1818, pp. 550-561. Also MS. prescription in the Author's hands. Phil. Trans. Ixxvi. 313.

^ The Lettsomia are handsome climbing plants from the East Indies, and /have long been known as Ipomaa, but the earlier name is now restored to them. See Bot. Mag. 2628 ; Kew Index. A beautiful shrub now included in Freziera has also been known as Lettsomia, the name bestowed in 1794.

* Dr. John E. Wolff, professor of Petrography and Mineralogy at Harvard University, informs the Author that Lettsom's specimens are now presumably incorporated in the great collection which is under Dr. Wolffs care. Lettsom also sent plants of Turkey Rhubarb to America in 1786 for cultivation ; and he presented books to Dickinson College, Carlisle, Pennsylvania, on its founda- tion in 1783. See Mem. i. loi, 192. Dr. Rush named a tract of land in Pennsylvania after Lettsom ; it was situated on Sugar Creek, which empties itself into the northern branch of the Susquehanna, and is shown in old maps of the district, as is another tract named after Fothergill. Sir St. C. Thomson, Trans. Med. Sac. L. xli.

X THE MANGOLD-WURZEL 105

Lettsom bestowed much pains on the introduction of the mangold-vvurzel into England in 1786, and calculated that a square yard of his garden planted with it produced fifty pounds of salutary food. It disappointed at first the hopes of its promoters, and a rhymester made Lettsom and his mangold-wurzel objects of ridicule. But he was justified in the end, and half a million acres in the United Kingdom are to-day planted with this useful root.^ He urged also the use of maize-flour to be mixed with that of wheat in making bread, then at a high price, and showed that it would reduce the cost of the quartern loaf from eightpence to sixpence. He also advocated a sort of " hasty pudding," made with the same Indian flour and boiling water, after the fashion of Scotch porridge.

The pen of Lettsom was ever busy. Many of his publications took the form of " Hints," and their subjects ranged over a wide area. Hints respecting Crimes and Punishments, respecting Wills and Testaments, respecting Persons imprisoned for Debt ; Hints respecting the Deaf and Dumb, respecting Schools for the Poor, respecting a Repository for Female Industry, for promoting a Bee Society ; Hints respecting a Village Society (in happy Camberwell), respecting Female Servants, respecting the Chlorosis of Boarding Schools, respecting Human Dis- sections, respecting Useful Literature ; Hints addressed to Card Parties — such were some of his topics. We may perhaps smile at his method of addressing the public. Here was indeed no stern reformer ; his academic Whig opinions never came into conflict with the powers that be ; nay, it was bad literary form to express himself with decision ; it was enough to say : " The man of urbanity, who reflects upon the fatal carnage of war . . . must unavoidably regret," etc. Yet a perusal of his Hints will show us that most of them contain suggestions of value ; some bore fruit in his own time in works of social improve- ment ; others held the germs of reforms for which the

^ An Account of the Culture and Use of the Mangel Wurdzel or Root of Scarcity, translated from the French of the Abbe de Commorell, 4th ed. 1788. Preface signed by Lettsom. He boiled the leaves for eating at his own table. Nichols, Lit. Anecd. ix. 40 ; Mem. Lettsom, i. 106, iii. 117.

io6 DR. LETTSOM

CHAP.

world was not yet ready. Critics indeed and malign opponents were not wanting. An entertaining article on " Dr. Wriggle, or the Art of Rising in Physic " came out in 1782, in which his weaker traits, of course grossly exaggerated, were played upon by a jealous fellow- physician.^ It was true that he liked to be in the public eye, and to see his portrait and memoir in a magazine ; but his love for the role of a philosopher and philan- thropist was based on real kindness of heart ; voice, pen and purse were equally at the service of all good works.

It was a day of the formation of societies and institu- tions for all manner of useful purposes ; a large number of these sprang up in London from the year 1780 onwards. There were societies for the Suppression of Vice, for the Publication of Select Religious Tracts, for the Encourage- ment of Good Servants, and for many other objects. Some became permanent and useful institutions ; others were ephemeral. Lettsom was President of some of these societies, and Vice-President of others ; his part in the Humane Society will be spoken of elsewhere. He took also no little interest in the reform of prisons.^

In dealing with the poor he recommended the system of relief used by the Society of Friends ; remove, he said, the causes of distress : principiis obsta. His desire to help the poor in London impelled him to find some means whereby scrofulous children could obtain the benefits of sea-bathing in a climate adapted to their cure. Associ- ating with himself two other men of public spirit, J. Nichols and Rev. J. Pridden, he purchased in 1793 two acres of land on the cliff at Margate, and here founded the General Sea-Bathing Infirmary, which was opened in August 1796. The original building has since been greatly added to, the number of patients accommodated

^ The arts by which Dr. Wriggle succeeded to Dr. Worthy (Fothergill) are detailed. Westminster Magazine, 1782, p. 466 ; Mem. Lettsom, i. Corresp. p. 21.

• Lettsom was consulted on the disinfection of Newgate after the death of Lord George Gordon from fever in that prison in 1793. He took a leading part in setting up the statue of John Howard in St. Paul's Cathedral, and in introducing to the public James Neild's accounts of the state of prisons from 1803 to 1813 {Gent. Mag. ; Mem. Lettsom, i. 109).

X THE SEA-BATHING INFIRMARY 107

has increased from 40 to 180, and the institution, under its present title, the " Royal Sea-Bathing Hospital," continues to carry on a work of the highest usefulness, which has been imitated in other places. Lettsom much enjoyed his yearly visit to the Infirmary, driving down from London through the night, and spending three days at the place ; it was almost the only holiday he ever found time to take. Three of the wards still bear his name, and the hospital is an abiding monument of his genius.^

Lettsom enjoyed for many years a large income from his practice ; it reached £5000 before he was forty-five years of age, and even rose to £12,000 in a single year. He was extraordinarily quick in seeing his patients. Meeting Dr. William Saunders at a consultation one day, he showed him his long list. " My dear doctor," said Saunders, " how do you manage ? Do you write for them by the dozen } or have you some patent plan of practising by steam — my much esteemed friend ? " His fondness for the fair sex set the lying tongue of scandal moving, and his foibles did not escape the satirists, who wrote of him :

When patients used to come to I,

'Twas " I physics and I sweats 'em,"

When after that they chose to die. It did not grieve — I. Lettsom.

In generous deeds I gave my pelf. And though the world forgets 'em,

I never shall forget myself — -^

What's due to Coakley Lettsom. ^

^ Hints, iii. 235 ; Gent. Mag. 1797, ii. 841 ; 1816, i. 17. Information from the Secretary of the Royal Sea-Bathing Hospital.

* The Wonderful Magazine and Marvellous Chronicle, 1793, i. 346 ; [W. Wadd], Nugce CanorcB, 1827, p. 15 ; Notes and Queries, March 10, 1906, 191 ; March 17, 210. A proprietary medicine, " Lettsom's Liver Pills," is still sold at a druggist's in Aldgate. The version there displayed is :

"I, John Lettsom, Blisters, bleeds and sweats 'em. If after that they please to die,

I, John, lets 'em."

io8 DR. LETTSOM chap.

He was indeed extremely generous with his money, jingHng it in his pocket, giving to those who asked him, and subscribing to every philanthropic obj ect . A Camber- well tradesman solicits the loan of twenty pounds for a short time. " A short time ! " quoth the doctor, " I might as well give it thee ; go, make good use of it." An old merchant in the American trade had fallen into trouble, Lettsom visited him, sick, in his Essex home, amongst the familiar trees which he had planted, now to be given up to others. The kind doctor left a cheque for his needs, and purchasing the freehold of his house, presented it to him for life.^

Late one night Lettsom's carriage was stopped by a highwayman, who put a pistol to his breast and demanded his money, which the doctor gave. The man's genteel appearance and agitated manner showed, however, that he was no common thief. Lettsom reasoned with him, and gave him a card with his address, asking him to call upon him. Two weeks afterwards he came and told his troubles, and how he had lately been driven to such, desperate ways, and that this was only his second attempt. Lettsom left no stone unturned until he had reclaimed him ; eventually he became an officer in the army, where he did honourable service. Pratt relates also a journey Lettsom made into Wales to see a once wealthy merchant, at the suggestion of John Howard, who had met the sick man's amiable daughter at an inn. Lettsom left with his patient a small closed box, containing a prescription which would, he said, do him much good ; it contained cheques from the doctor and his generous friend.^

His friend, Sir J. Martin, replied to the lampoon :

" Such swarms of patients do to me apply, Did I not practise, some would surely die. 'Tis true, I purge some, bleed some, sweat some, Admit I expedite a few, still many call. I. Lettsom."

For other rhymes, see Dr. F. Parkes Weber, Aspects of Death and Life, etc., 3rd ed. 310; Lancet, 1918, i. 126.

^ W. Armistead, Select Miscellanies, 1851, iii. 208.

* Pratt, Gleanings, yth ed. 1802, i. 182. Lettsom was very kind to Captain J. Carver, explorer of the Indian Territories, and to his family. See Fothergill. Works, iii. p. Ixxx note ; Carver, Travels through the Interior Parts of North America, 3rd ed. 1781.

X HIS MODE OF LIFE 109

Like Fothergill, Lettsom saw many patients without fee, and took nothing from necessitous authors and clergymen. His lavish habits made a large income a necessity to him, and kept him labouring without cease to secure it. Quick and methodical, he seldom wasted a moment ; he rose early and sat up late ; whilst visiting his patients in the morning he would walk for a couple of hours or so, and then take up his carriage, sometimes using three pairs of horses during the day. " I dine with my wife," he says, " once a week." He mentions in a letter in 1795 that he has attended 82,000 patients ; but he enjoys his work. " I love my profession, and it loves me." His friend Cuming often reasoned with him on the incessant hurry in which he lived, as he did also on his lavish benefactions ; Lettsom should apply for an Act of Parliament to extend the day to forty-eight hours. He kept up a very large correspondence, answering every letter he received, and generally at once ; often writing currente calamo in his carriage. His letters are lively and interesting ; and he paid much attention in his set papers to literary style. His memoir of Fothergill shows this at its best ; each topic is elegantly introduced in balanced phrases, with frequent classical quotations well displayed, and Englished in a footnote. This essay is a typical specimen of the polished literature of the period. A few sentences may be quoted introducing Fothergill's labours on the subject of education.

But the most effectual barrier against corruption of manners and the influence of vicious example, is an early and guarded education. As the sun is to the external, so is learning to the intellectual eye ; it enables the mind to distinguish truth from error, endows it with stabihty and strength to combat vicious propensities, and renders it susceptible of enjoying the felicities of life, without adopting its follies, or entailing its miseries. To promote this useful education. Dr. Fothergill was a liberal advocate.

Lettsom 's large acquaintance included many of the literati of his time. Of Dr. Johnson he writes : " He was sometimes jocular, but you felt as if you were playing

no DR. LETTSOM chap.

with a lion's paw. . . . He had a heavy look, but when he spoke, it was like lightning out of a dark cloud." A letter to Boswell contains some plain speaking and advice upon his friend's frailties.

In course of time Lettsom built himself a country villa at Camberwell, then a pretty village, four miles south of the city. The spot was open, and commanded a wide prospect on every hand. It included the spires of London, a long stretch of the vale of the Thames, from its more rural banks to " busy Deptford's vessel-crowded shore," and some of the Essex and Hertfordshire hills beyond. The eye lit

On Hampstead's street-clad slopes so high. Or Harrow's far conspicuous hill,

and turning southward over Surrey uplands rested on the primitive oak forest where Queen Elizabeth hunted, portions of which at that time still clothed Honor Oak Hill and the slopes of Sydenham. Here stood his villa, called Grove Hill, in the midst of pleasure grounds, orchards and paddocks. A botanical garden, well garnished with labels, and an arbustum ; a reservoir, a cold bath and a Cupid's fountain ; a temple of sibyls and a Shakespeare walk and statue — such were some of its adornments. The sixty-four hives of his apiary were each distinguished by the name of a nation.

Here sheets of living verdure charm the eye ; There glow rich tints that with the Tyrian vie. Now the gay garden with its varied sweets My raptured sense a blooming Eden greets : ^ Now from the turret's height my eager glance I roll delighted o'er the vast expanse ; Now range yon ample lawn's luxuriant swell. Or pensive wander down yon shadowy dell ; Or in the cool of eve's declining beam. Seek the sweet cottage and its spacious stream ; While soft around the genial zephyr blows. And murmuring waters soothe me to repose. ■'^

^ From a poem by Rev. T. Maurice (author of Indian Antiquities), in Grove Hill, a Rural and Horticultural Sketch, with many illustrations, and Catalogues of Fruit Trees, Plants and American Trees and Shrubs, 2nd ed. 4to, 1804, John Scott of Amwell also apostrophised his friend and fellow-Quaker :

X HIS VILLA AT CAMBERWELL in

Tablets adorned the house on every hand, with emblems of the Seasons, the Arts, Peace and Commerce, Sovereignty and Truth ; a central group displayed the Isis of Sais. Ever3rthing was correct, elegant and classical. Within the villa, a west wing contained the library, museum and greenhouse ; the first had sixteen departments, each surmounted by a bust ; that of Fothergill presided over medicine and botany. A museum of ores amd natural and curious objects was spread upon the tables. It was a house of beauty and of learning, too rarely visited by its owner, although he loved to entertain his friends within its portals. Engravings portray for us its various aspects, with the doctor standing in his garden amongst his lady guests. Lettsom's house is no longer standing, but another villa on his grounds, near to it, and once occupied by his friend Dr. Smith, still remains.^

" Where Grove Hill shows thy villa fair, But late, my Lettsom, there with thee 'Twas mine the tranquil hour to share — The social hour of converse free ;

" That business, with fatiguing cares. For this delightful seat of thine Such scanty store of moments spares. Say, Friend, shall I for this repine ? Were it the commerce of the main, Or culture of the teeming plain, From blame or pity I could scarce refrain.

" But O ! to alleviate human woes. To banish sickness, banish pain. To give the sleepless eye repose, The nerveless arm its strength again ; From parent eyes to dry the tear, The wife's distressful thought to cheer. And end the husband's and the lover's fear ;

" Where want sits pining, faint and Ul, To lend thy kind unpurchased aid, And hear the exertions of thy skill With many a grateful blessing paid — 'Tis luxury to the feeling heart, Beyond what social hours impart. Or nature's beauteous scenes, or curious works of Art ! "

Poetical Works, 2nd ed. 1786, p. 190.

1 This villa is now named Grove Hill House, and is in the occupation of Dr. Couper Cripps. Most of the park and gardens have been built over ; they extended southward down Camberwell Grove as far as what is now called Lettsom Street. Some of the old trees — a cedcir before the front door.

112 DR. LETTSOM

CHAP.

When Jenner discovered the protective value of the cowpox, Lettsom was entering on his later decades. He had been a champion of Inoculation all his life, but he saw quickly that the new method was a great advance upon the old, and he threw the whole force of his influence on the side of Vaccination. He was in close touch with Jenner, who treated him with respect and confidence ; " he fought his battles " in the metropolis, " and often signally vanquished his opponents," and he took a leading part in founding thie Royal Jennerian Society in 1803. Lettsom gave evidence before the House of Commons Committee on Vaccination, and he used his pen to persuade a divided profession and a puzzled public, with all the rhetoric he could command. The cow, that " salutiferous animal " whose " lactarial fountains " nourish our little ones, was described, figured and extolled. He called upon all classes of the community to claim their complete deliverance from the ravages of the most fatal malady under heaven. Mothers, he cried, shield the endearing features of your infants under the cBgis of Jenner ! If the smallpox was a devouring river and Inoculation a boat on which to cross it, surely Vaccination was " an adamantine bridge." Saul and David had slain their ten thousands, but how many had Jenner saved ! The final establishment of Vaccination, after years of hard fighting, both in Great Britain and in America, owes something to the medical insight and the strong human instincts of Lettsom.^

In his later years Lettsom encountered many troubles. His eldest daughter, two sons — one in the medical and one in the legal profession — and both the widows of these

a fine horse-chestnut, mulberry, medlar and wych elm — no doubt date from Lettsom's period. A view of the Fountain and Thatched Cottage adjacent to it is in Beauties of England and Wales, by Gastineau ; both remained imtil within living memory. There is still a thatched cottage near by, in Camberwell Grove. An account of a rural fete at Lettsom's villa, May 22, 1801, when five hundred talented and elegant guests were entertained, is given in Gent. Mag. 1 80 1, i. 476. See also Circuit of London, vol. v.

1 Lettsom, Expositions on the Inoculation of the Smallpox and of the Cowpock, 2nd ed. 1806 ; Hints, iii. ; Memoirs, iii. 402, etc. ; J. Baron, Life of Jenner, i. 517, 569, 576, 586 ; ii. 31, 69.

X SOBER AUTUMN HUES 113

sons, all passed away within a few years ; " My path," he said, " seems to be over the ashes of my children." He had high hopes of his eldest son, whom he had trained as a physician with unsparing pains, and the young man seems to have been fully worthy of them.^ An enduring sadness fell upon the father's life, yet, quaint even in his sorrow, he remarked that his son had quitted " the Society of Friends for that of Angels." A train of adverse circumstances, due in part to his own prodigality, but chiefly to the accommodation of a near relative, involved Lettsom in heavy losses, and he had to part with his beautiful villa and most of his library and museum ; a large fortune, which was later awarded to him, he did not live to enjoy.

But he worked steadily on, neither crushed nor em- bittered by adversity, attending to his lessened practice, writing, speaking, enquiring, proposing — for the public and private good. Time failed him for all that he still wished to do. " There was no crabbedness in his age. It was not like a winter, but like a iine summer evening, or a mild autumn, or like the light of a harvest moon." ^ He enjoyed in his latest years the friendship of a yoimg man of scientific tastes and ceaseless activity of mind like unto his own, Dr. T. J. Pettigrew. He was Lettsom's fidus Achates, and became his biographer. " I am seventy years of age," writes Lettsom to Dr. Joshua Dixon, of Whitehaven, " and would fain live another year to effect some literary objects before I emigrate ad sedes csthereas unde negat redire quemquam." A few days after writing these Hnes an attack of acute illness came upon him, said to be rheumatic fever, but probably septic poisoning, following a post-mortem examination. But he must needs go out to visit a poor patient in Whitecross Street ;

^ This son left an orphan, William Nanson Lettsom (b. 1796, d. 1865), who became a scholar of some distinction : he translated the Nibelungenlied (1850), and pubUshed studies on Shakespeare. See Diet. Nat. Biog. ; Notes and Queries, 3rd series, viii. 500, ix. 49. Another son, Samuel Fothergill Lettsom, died at Boulogne, 1844, aged sixty-five years. Lettsom's descendants are extinct in the male line, but are represented by families of Gronow and Elliot through female descent, and by Mrs. T. C. Colyer-Fergusson.

* Quoted by Pettigrew of Lettsom, from Southey's The Doctor.

I

114 I^R- LETTSOM chap.

he could with difficulty be lifted from the carriage, and survived but a few days ; talking to Pettigrew almost with his latest breath of the Philosophical Society — ^the child of his old age — of which he was the President. He died November i, 1815, and was buried in the presence of a concourse of his poorer patients, and of a few Friends, including William Allen, in the Friends' ground, Bunhill Row, where lie George Fox and Edward Burrough.

Lettsom was all his life a member of the Friends, although his attachment to the society was not close nor strict ; he attended its meetings not infrequently, and he could on occasion offer a spirited defence of its principles. But his outlook was from an early period a wide one, regarding all men as equally the children of one creative Parent ; hence he was tolerant of all creeds, and governed by the same instinct which led him as a young man to free his slaves. Boswell wrote truly of him :

His liberal mind holds all mankind As an extended nation.

' ' I considered, ' ' he wrote in 1788, ' ' the tenets of different religions and professions ; and I thought that there was only one true religion, consisting in doing unto others as we wish others should do unto us. A demure face and sanctimonious exterior I appreciated as nothing, where beneficence was wanting." He held advanced views on the Old Testament, which would now hardly be considered unusual, condemning the evil actions of some of its saints and heroes. In an age when unbelief was common among the studious, Lettsom did not waver from his faith in a Deity of infinite perfection and goodness, whose unmerited blessings he gratefully acknowledged.^

Those who knew Lettsom best, best loved him : his foibles were on the surface : Nichols and Pettigrew held him in real affection : "an Israelite without guile "

^ He is said to have printed an " Essay on Religious Persecution " for presentation to his friends. Fothergill, Works, iii. pp. xcii-xcvii ; Gent. Mag. 1803, 897 ; 1804, 19 ; 1815, ii. 473 ; Verses by Boswell, idem, 1791, i. 367, 564 ; Lettsom, MS. Letter, Jan. 22, 1788, in possession of J. J. Green of Hastings ; also MS. Letter to S. J. Pratt, Feb. 15, 1797, in private hands.

X HIS CHARACTER 115

writes the former, and a man of " undeviating friendship " ; he won, too, the esteem of many others. In his own pro- fession he holds a worthy place in that succession of labourers, alert and untiring, by whom from age to age the practice of medicine is advanced ; and the establish- ment of the Medical Society upon a liberal basis was a real achievement. The spirit of emulation was strong in him. His influence in the community was one that made for good, for righteousness, and for the law of kindness ; the world was a little better for his life. Throughout that life he ever remembered his debt to Fothergill : " As a medical man," he said, " my character was solely reflected from the patronage of Dr. Fothergill." " My medical creation was his. " "I can hardly recollect a week without some instance of his affection and friendship."

Lettsom was tall in person, spare and erect, his com- plexion yellow from the West Indian climate, and the face deeply Imed. His eye beamed and sparkled with anima- tion. His figure in Medley's group of the Medical Society is instinct with geniality, conciliatory, alert ; and humour is latent in the line of the thin lips, and the deep dimples of the cheeks. He dressed very neatly in the Quaker attire, but not with strictness ; and wore a short wig. He was frank, genial and familiar in his address. Cold bathing night and morning, an equable and cheerful temper, and regular habits maintained him in good health ; and Pettigrew states as a sign of his moderation that he would seldom exceed three or four glasses of wine after dinner. He drank strong coffee at night, sitting up very late at his writing.

The pilgrim of to-day who would see some token of Lettsom should visit the house in Bolt Court, which became the old home of the Medical Society by the gift of its founder in 1788. It stands opposite the site of that in which Dr. Johnson lived and died. He must turn out of the busy highway of the Strand, full of noise and move- ment, finding, if haply he may, a narrow alley which opens into a quiet court. There he will come upon an old square house, whose front presents the calm dignity

li6 DR. LETTSOM chap.

of age. Let him look upon its wide-framed windows and enter its antique doorway, and if he can disregard the bustle of close packed offices which now fill the house, let him note its massive walls and an arched recess upon the staircase where perchance a statue of Hygeia once stood. Above all let him gaze at the tablet above the door, where the genius of the place has left his mark. Little touched by age, the graceful mouldings still portray the Isis of Sais : she is standing before a pyramid, having a sphinx on either hand : and below, within the coiled serpent of eternity, are the words, ErU EIMI HAN TO TErONOX, KAI ON, KAI ESOMENON, KAI TON EMON HEHAON OTAEU nn ©NHTXIN AHEKAAT^EN. (I am all that hath been, and is, and shall be, and no mortal hath yet drawn aside my veil.) Here let our pilgrim pause, ere he turns back into the stream of action, and ponder, as Lettsom would have us ponder, before the majesty of knowledge and the riddle of life.^

^ Plutarch, De Iside et Osiride, c. ix. " The temple of Athene, whom they account to be Isis, at Sais, had this inscription " [then follows as in text]. Isis was the " universal mother nature " (Apuleius), the revealer of medical know- ledge. See also Diodorus Siculus, 1. i. ; and The Times Literary Supplement, Nov. 1917. According to Routh (Oration, 1859, Hist, of the Medical Society of London, p. 20) the bas-relief (excepting only the snake) is taken from a design of Gravelot's, engraved by Foudrinier, as a head-piece to section xii. of Warkwall's Inquiry into the Life and Writings of Homer.

Since the text was written the house in Bolt Court has been sold for demoli- tion, and the tablet removed to the library of the Medical Society.

Pettigrew brought out in 1817 Memoirs of the Life and Writings of J. C. Lettsom, with a Selection from his Correspondence, in two volumes, to which a third was added later. See also Mem. Pettigrew in Med. Port. Gallery, iv. ; Lettsom, Mem. Fothergill ; his Hints to promote Beneficence, etc., 3 vols., and his other works, including, besides some already mentioned. The Natural History of the Tea Tree, etc., 1772 ; Of the Improvement of Medicine in London ; The Plan of a General Dispensary, 1773 ; Observations on Dr. Myersbach's Medicines, 1776. His Fothergillian essay (1791) on The Diseases of Great Towns and the Means of Preventing them does not seem to have been printed. MS. Letters to Lettsom and his friends from Sir Mordaimt Martin and Dr. James Anderson, 1789 and 1790, on the cultivation of roots, and from John Player, 1802 and 1803, on the diseases of plants, etc., are in Lib. Roy. Soc. Med. See also Nichols, Lit. Illust. and Lit. Anecd. ; Archceologia, vii. 414 ; Europ. Mag., 1786, ii. 395 ; 1815, ii. 392 ; Gent. Mag., 1815, ii. 469, 577 ; J. Jenkins, op. cit. pp. 891 £f. A picturesque sketch of the old Quaker burial-ground in Tortola is in Friends' Intelligencer, Ix. 419. Dr. J. F. Payne's article on Lettsom in Diet. Nat. Biog. contains a few inaccuracies. An excellent appreciation of him is contained in Sir St. Clair Thomson's Presidential Address to the Medical Society of London ; see its Transactions, xli., 1918. A letter of counsel to Lettsom on the occasion of his marriage, from his early patron Samuel Fothergill, is often found in Friendly collections ; see J. and I. Comly, Friends'

X THE RIDDLE OF LIFE 117

Miscellany, vi. 285. Lettsom's medical and other papers passed to Pettigrew, and were ultimately dispersed in 1906, many being sold at auction. Mr. T. C. Galyer-Fergusson of Sevenoaks, who is connected with the Lettsom family, possesses among other papers his MS. " Recollections " of early life, 31 pp., which were used by Pettigrew. There are two portraits of Lettsom in oils at the Medical Society of London, besides that in Medley's well-known group described in Chapter XII., and there are several engraved portraits by W. Skelton and by HoUoway.

CHAPTER XI

OTHER MEDICAL FRIENDS

Ex amante alio accenditur alius. — Augustine, Confessions.

Thou hast made me known to friends whom I knew not. Thou hast given me seats in homes not my own. Oh, grant that I may never lose the bliss of the touch of the One in the play of the many. — Rabin-

DRANATH TaGORE.

Dr. Alexander Russell

Some of the medical friendships of Fothergill dated from his Edinburgh days. Russell, Cleghorn and Cuming were his fellow-students, and while life lasted they were mutual friends.

Alexander Russell sprang from a good stock in Edin- burgh. He was one of the founders of the students' Medical Society in that university in 1734. Soon after finishing his studies he went out to Turkey, settling in the year 1740 at Aleppo as medical officer to the " English factory," a community of prosperous and intelligent merchants. Here he made for himself a high position ; he leamt the language and ways of the people, and his own skill in medicine, contrasting with the ignorance of the native practitioners, gave him in course of time an entrance to all ranks and races in the city, then as now a motley population. The Pasha himself became his friend, often consulting him and leaning upon his advice in matters of importance quite outside the medical role. Many an accused man owed his life to the doctor's kind offices. Sometimes the Pasha would tell the culprit that in his opinion he certainly deserved death, but that he durst not order it, for the English doctor insisted on

118

CH. XI DR. ALEXANDER RUSSELL OF ALEPPO 119

mercy ; and this even when Russell knew little or nothing of the matter, till the poor wretch came to his house to fling himself at his feet in gratitude. Russell himself remarks that money went a long way in judicial decisions, but there was this in their favour : a smaller bribe was required for deciding right than for deciding wrong. Nor were the doctor's services to the factory less valued, and his reputation spread far amongst the provinces of Turkey and even in the capital itself.

His active mind enquired into the conditions and circumstances of life in the city of Aleppo and the district, the arts and customs of the people and their religion. Besides the diseases — especially plague and the Aleppo evil, both then little known in England — the natural features of the country, climate, soil, fauna and flora, all furnished material to his note-book. He took much pains to obtain the seeds of the true scammony plant, at that time much used in medicine, sending them home to Collinson and Gordon, by whom they were grown. He supplied also his friend Fothergill with the beautiful Arbutus andrachne, a kind of strawberry-tree.

After spending fifteen active years in Turkey, Russell returned to England. Fothergill, ever on the alert to promote the spread of knowledge, urged him to publish his researches, and he embodied them in The Natural History of Aleppo,'^ one of those ample quarto monographs, with large print, wide margins, illustrations and footnotes, in which our forefathers delighted. The descriptions are so accurate and judicious as to give a completeness and permanent value to the work. The author was elected to the Royal Society in the following year, and contri- buted several papers on natural history to its Transactions.

Russell now settled in London, having obtained the M.D. degree from Glasgow University and the licence of the College of Physicians of London, and he was soon appointed a physician to St. Thomas's Hospital, where

^ Published in London, 1756 ; in a second edition, enlarged ^vith notes by Dr. Patrick Russell (who succeeded his brother at Aleppo), 1794 ; also trans. into Dutch, at Leyden, 1762.

120 FOTHERGILL'S MEDICAL FRIENDS chap.

he was a colleague of Akenside. Here he had a short but honourable career, being highly valued for his ability, the liberal and easy method of his teaching, and the kindness of his character. He was consulted by the Privy Council upon a threatened outbreak of plague, on account of his special experience in the east, which had included visits to the most famous lazarettos. His answers to their enquiries were, we are told, so pertinent and satisfactory that he was asked to draw up a plan for preventing the spread of the disease, should it invade England. His useful life was cut short by a putrid fever at his house, No. I Church Court, Wallbrook, in 1768 ; the disease proving fatal notwithstanding the utmost endeavours of Fothergill and W. Pitcairn. The former read, a year later, an Essay on his character before the Society of (Licentiate) Physicians, a society in which Russell had taken a leading part. Addressed as it is to a small company who knew him well, this record of friendship for " our Russell " strikes a tender chord. Fothergill dwells upon his even, cool and consistent temper, polite without flattery, with a freedom of behaviour as remote from con- fidence as from constraint, disinterested and generous. His mind was imbued with a just reverence for God and with duty towards his fellows ; a gentleman, without reproach.

Russell was a good clinician, and wrote papers on palsy, hydatids, general emphysema, and the use of corrosive sublimate and of mezereon in syphilis. He seems to have had much success in the treatment of fevers :

At his calm bidding the fierce flames which bum

Our mortal frame sank harmless : he subdued

Unto an even heat their blazing fires ;

And when he drew the poison fangs of Plague,

Wresting from Fate itself her scissors keen.

He left to these grim shapes but half their dread.^

^ " Innocuas placide corpus jubet urere flammas, Et justo rapidos temperat igne focos. Extorsit Lachesi cultros, pestique venenum Abstulit, et tantos non sinit esse metus."

Inscribed on Trotter's stippled portrait of Dr. A. Russell, published in his Memoirs of Russell by Lettsom, 1786. The lines are taken from Locke's

XI DR. CLEGHORN OF DUBLIN I2i

Dr. George Cleghorn

George Cleghorn was born at Granton near Edinburgh in 1716, being the youngest son of a small farmer who died early. The boy was placed at the age of fourteen years as pupil to Alexander Monro primus. This early association with the great anatomist and founder of the Edinburgh Medical School, and the years he spent under his roof, gave to the young student his bent in life ; whilst the example of Monro's unremitting work and the sweet- ness of his disposition had their effect in forming the character of the fatherless lad.^ After Fothergill came to Edinburgh, Cleghorn and he became intimate friends, working together, both in the university and in the medical society, of which the former was one of the first members.

He must have been a precocious student, for he was but nineteen years old when he left Edinburgh in 1736, having been appointed surgeon in the 22nd regiment of Foot stationed in Minorca, at that time belonging to Britain. His early success did not lead him to cast off his studious habits. On the contrary, during the thirteen years of his stay in Minorca he continued to read, and spent much time in the investigation of fevers and other epidemic diseases, and in gratifying his passion for anatomy. He often made dissections, both human and of apes, which latter he procured from Barbary, and compared their structure with the accounts of the best authors. He had many books with him, including his classics, and his friend Fothergill kept him supplied with others, searching the London shops for such as he needed in his studies.

Cleghorn communicated to Fothergill in letters, written

poem addressed to Sydenham, 1668. See also Fothergill's Essay on the Character, etc., 1769 ; Med. Obs. & Inq. i. 13, 296, ii. 88, iii. 146, i8g, 397 ; Mem. Lettsom, i. 22, 96 ; Phil. Trans, xlix. 445, li. 529, Iii. 554, Iviii. 140 ; Munk, Roll Roy. Coll. Phys. ; Hunter-Baillie MSS. i. 133, Roy. Coll. Surgeons. ^ He writes of his old teacher to Fothergill in 1742 : " Quem mitem praeceptorem, egregium monitorem, optimum' amicum, expertus sum . . . quem vivida virtus etiam in vitae carceribus ad summos evexit honores." See Letter below.

122 FOTHERGILL'S MEDICAL FRIENDS chap.

in fluent and elegant Latin, his observations on the climate and epidemic and endemic fevers of the island. His friend read them with much pleasure, and sent them to Cuming with a few words of appreciation. The letters give a charming picture of the affectionate friendship between these comrades. " Vale, mi Johannes," he writes, " iterum, iteramque, vale." ^

Cleghorn left Minorca in 1749, and came in the next year to London, where, at Fothergill's suggestion, and with his literary assistance, he published his Observations on the Epidemical Diseases in Minorca, with an account of the climate and inhabitants, and of the endemic dis- tempers. The work is well done ; it maintains indeed the antique form, quoting Hippocrates and Celsus often as well as the modems ; yet it is based upon the facts he has himself observed, the natural course of fevers, their reaction to remedies, and the comparative success of different forms of treatment. His model is " the incom- parable Sydenham." W'Tien, however, he reasons on the facts he does not escape the erroneous theories of the time. The principal chapter in his work deals with tertian fevers, the commonest type of what we know as malaria. Experience taught him that purging and bleeding were here often hurtful, and in some cases he omitted them entirely. When the sj^mptoms were moderate and the strength good, " I frequently trust," he says, " the whole business to nature." But the bark (cinchona), against which medical prejudice was still strong, was his main remedy, though he did not generally give it till the fifth day, when he would prescribe 5 or 6 drachms of the

1 " VII Kal. Quinctil. A.S. 1742." Again in 1738 he writes : " Fac ut sodalibus meo nomine gratuleres, et sciant quod horum memoria usque adeo meae menti inhaereat, ut nunquam nisi cum extremo spiritu demittatur." The climate was no light burden. " Epistolam ... ad finem perduxi non absque molestia, scias enim me earn scripsisse aastuante summopere coelo, solo indusio vestitum, et sudoribus obrutum.

O, qui me gelidis in vallibus Haemi

Sistat, et ingenti ramorum protegat umbra ! "

Virgil, Georg. ii. 488.

Cleghom's letters to Fothergill are preserved, neatly copied out, in a MS. volume in the library of the Medical Society of London. (W. c. 22.)

XI THE ISLAND OF MINORCA 123

powder to be taken in the course of twenty-four hours. The certainty of its results in controlling the course of the fever leads him in a humorous mood to quote his favourite Virgil [Georg. iv. 86) :

Hi motus . . . atque haec certamina tanta Pulveris exigui jactu compressa quiescent.

He was convinced, he says, of the innocency and efficacy of the remedy, and he heartily wished he had given it with more freedom. Elsewhere he writes of the large spleens commonly found, and which he had noted in the sheep also, but he does not connect them with the fever. Some account follows of cholera, dysentery (in which he gave ipecacuanha), pleurisy and smallpox, with reports of his own cases. He also devotes much space to a record of the weather, and of the epidemics during the course of six years. An introductory chapter gives a clear and concise description of the island of Minorca, its vegetable and animal productions, and the conditions of life upon it. The people were gay ; one-fourth of their time was made up of holidays, and they were fond of feasting and of " poetical disputes." Snails were much used for food by the poorer families. Cleghom's book was well received ; it passed through five English editions, and was translated into German.

Whilst in London Cleghorn attended the lectures of Dr. William Hunter. In 1751 he settled in Dublin, and, emulating Monro and Hunter, began himself to give lectures on anatomy. Two years later he was appointed Anatomist in the School of Medicine attached to Trinity College, a school still in its early and rather troublous days. In 1761, the Lecturer on Anatomy having been dismissed as the result of a dispute, Cleghorn was elected in his stead. In this office he continued many years, lecturing in English instead of in Latin, to ever-increasing classes of students, drawn even from beyond the seas ; the school growing under his influence in reputation and efficiency. He was made Professor of Anatomy in 1785. In the meantime he practised as a surgeon in Dublin

124 FOTHERGILL'S MEDICAL FRIENDS chap.

and won for himself both fame and fortune. " No man knew Dubhn better, and few could so readily direct a professional man as to the manner by which its inhabitants were to be pleased." Two papers from his pen were read before the Medical Society (of Physicians) in London : one on the extraction of a goose's feather from a girl's throat by means of a whalebone with springs attached ; and another on an aneurysmal varix of the arm following venesection.

Having received a doctor's degree in 1768, Cleghom began in 1772 to depute much of his lecturing to his favourite pupil Dr. Purcell, and later to his nephews, William Cleghom and James Cleghom, sons of a deceased brother, whose large family he brought over to Dublin that he might attend to their education. He continued to give to crowded audiences a short course of lectures upon the animal kingdom, pointing out its various tribes, and how the several organs of each creature were fitted to its mode of life — a sign of the wisdom of the Creator.

As age advanced, asthma and dropsy and " a weighty corporation of 19I stones " led Cleghom to decline all outdoor practice, and he lived mainly at his country house at Kilcarty ; where he died in 1789, honoured and beloved. His chief title to fame is that he placed upon a worthy basis the first School of Anatomy in Ireland. Cleghom was an original member of the Royal Irish Academy, and on the foundation of the Royal Society of Medicine of Paris he with his friend Fothergill were nominated foreign associates. The shrewd sense and justice of Cleghom's character are illustrated in a letter he wrote to his nephew Dr. Joseph Clarke, on the latter seeking election to the mastership of the Rotunda Hospital. " My stomach revolts against the usual mode of extract- ing promises, and engaging votes, before the governors can be apprized of the merits of the candidates. It is founded on a supposition that all men are actuated by selfish motives, regardless of the public good. If you gain the election, I hope it will be by means fair and honourable ; I would rather hear you had lost it, than

XI DR. CUMING OF DORCHESTER 125

that any others had been employed. Read the tenth satire of Juvenal, and reflect on the vanity of human fears and wishes." ^

Dr. William Cuming

William Cuming, Fothergill's most intimate medical friend, was born in 1714, the son of a merchant of high character in Edinburgh. Entering the Medical School of the university, young Cuming was one of the band of able students who founded the Medical Society there, reading himself the first paper before it, on Rabies canina. Leaving the university in the next year without taking a degree, he spent some time in further studies in France and Flanders, travelling in part with his friend, after- wards the well-known Dr. Robert Whytt, and attending the lectures of Boerhaave at Ley den. During a stay of three days in Rheims, the young men took out degrees in medicine at the university, after separate Latin examinations, " for a considerable space," in anatomy, physiology and various diseases. Later he visited London with a view to finding an opening for practice as a physician in a country town in England. Dr. Mead proposed Lynn, but Dr. Wm. Browne objected, because he had no degree from Oxford or Cambridge ; Norwich

^ In a poem, " The Medical Review," 1775, Dr. J. Gilbome depicts the physicians, surgeons and apothecaries of Dublin passing in procession to the Temple of Fame.

" Cleghorn in human structure can explore What no anatomist has found before ; By sons of Irish heroes ever loved For eloquence and surgery improved : Exhibits goodness whereso'er he goes, On rich and poor great benefits bestows, Like the sun rising, without bar or bound. Gives health and joy, and influence around."

Cleghorn's account of some rude stone monuments in Minorca in a letter to a friend, 1739, was commimicated to the Society of Antiquaries. See MS. Add. 6183, p. 58, Brit. Mus. See also Cleghorn, Index of Lectures (Dublin, 1756) ; his Memoirs, by Lettsom ; Mem. Lettsom, ii. 364, iii. 288 ; Foth. Works, iii. p. xcviii ; Med. Obs. & Jnq. iii. 7, no, 229, vi. 231 ; Edin. Med. & Surg. Journ. Ixiii. (1845) p. 95 ; Diet. Nat. Biog. ; Dr. T. Percy C. Kirkpatrick, History of Medical Teaching in Trinity College, Dublin, and references there given ; Kirkpatrick and Jellett, The Book of the Rotunda Hospital, p. 107 ; A. Macalister, James Macartney.

126 FOTHERGILL'S MEDICAL FRIENDS chap.

was then thought of. Whilst, however, he was seeking introductions to some of the chief famihes in the latter neighbourhood, Fothergill advised Dorchester, and Cuming accordingly went thither in 1739, carrying with him recommendations from influential physicians in London. Cuming was a man of modest and unaspiring mind ; paucis contentus vivere didici, he says of himself — " I have learned to live content with few things " ; but his sterling worth, his learning, and the interest he took in his patients, gave him in course of time a large practice amongst nearly all the county famiUes, who regarded him as not only their physician, but their friend. In 1752 he received the ad eundem degree of M.D. from his old university, and he was elected a Fellow of the Royal College of Physicians of Edinburgh soon after.

On the death of Dr. Alexander Russell in 1768, Fother- gill, who had a high regard for his old fellow-student, proposed Cuming's removal to London, but his attach- ment to the large circle of those who had given him their confidence in Dorset induced him to decline. Later on, when Fothergill was gone, Lettsom was his successor in the bond of close friendship with Cuming, although they never actually met until the former went down to see him in his last illness. Cuming had interests outside his medical work, having a fine collection of shells, and occupying himself during four years in caring for the publication of Hutchins' History of Dorset, which appeared in 1774 ; he was also a Fellow of the Society of Anti- quaries. He suffered from tenderness of the eyes for most of his life, and died at Dorchester of dropsy in 1788 ; his epitaph at that place states, that he " desired to be buried in the churchyard rather than the church, lest he, who studied whilst living to promote the health of his fellow-citizens, should prove detrimental to it when dead."

Cuming was a physician of high character, " chaste manners," and integrity ; a man of a kindly spirit, he never lost a friend he once made, and his life " glided on in a calm uniform stream " to its tranquil close. As a

XI DR. GILBERT THOMPSON 127

practitioner he was perhaps old-fashioned. He wrote Httle, but part of a long medical letter to a Dr. Oliver, dated 1755, in a close antique hand, has been preserved. In this he deals with the external use of a certain oil, by means of which a young lady had been cured of a true ascites, after, however, tapping had been performed. He gives copious quotations from Celsus and Aetius, Ascle- piades, and Oribasius, showing how the ancients used inunctions after bathing, as well as from Schenkius and Piso among the modems, and concludes with an elegant compliment to his correspondent from the pages of Cicero.^

Dr. Gilbert Thompson

Dr. Gilbert Thompson was a kinsman of Fothergill's. His grandfather and namesake founded in 1687 a school at Penketh, Lancashire, ancestor to the Friends' public school at that place. Here many well-known Quakers were educated, including Edmund Peckover, Lettsom, George Harrison, and Samuel Hoare. G. Thompson was the son of William Thompson of Warrington, and was bom in 1726. After serving as an usher in the family school, he left it to study medicine, graduating at Edin- burgh in 1758 with a thesis on Exercise. Coming up to London, and having money left him by his uncle in 1768, he entered into practice as a physician.

Thompson had good abilities, but he was bashful, cautious, and self-centred, and Fothergill, who opened his house to his young relative, sought again and again to arouse his dormant energies. He will be either a man or a mouse, said the doctor, according as he exerts him- self : " never any man hid his talents more under a bushel." After Thompson and Lettsom had spent an evening at his house, Fothergill was heard to remark that he would like to shake the two together in a bag,

^ See Foth., Works, ii. 368, iii. pp. Ixi, cxc, 115-142 ; Mem. Lettsom ; Nichols, Lit. Anecd. iv. 713 ; Hutchins, Hist, of Dorset, 3rd ed. ii. 391 ; Gent. Mag., 1788, i. 278, 364; MS. Letters to Oliver, in possession of J. J. Green ; Foth. to Cuming, 1748, at Haverford College ; and Huxham to Cuming, 1765, in the Author's hands.

128 FOTHERGILL'S MEDICAL FRIENDS chap.

and that it would much improve them both ; Lettsom's loquacity and Thompson's diffidence being shared between them. Thompson acted as secretary to the small Medical Society (of Physicians), and drew up at the desire of that society after Fothergill's death a short Memoir of his Life and Character, carefully and thoughtfully expressed. It is one of the sources used for the present volume. Dr. Thompson retained his quiet and unassuming manners throughout life, with an integrity of character worthy of his Quaker profession. He lived and practised in Size Lane, and afterwards in Salters Hall Court, Cannon Street, where he died in 1803. The occasional cultiva- tion of a gentle and rather formal muse led him in 1801 to publish a little volume of Select Translations from the Works of Homer and Horace, with Original Poems. These betoken a classical habit of mind, and a close familiarity with Homer and with the early British poets. Amongst the poems is a Latin epigram on Blanchard, the French- man, who was borne through the air by means of an aerostatic globe in 1793.^

Dr. Rutty

Dr. John Rutty, another friend of Fothergill's, came of an old family at Melksham, Wiltshire, where his father of the same name joined the Friends in 1692, and where the son was born six years later. Rutty studied medicine at Ley den in the great days of Boerhaave, and graduated M.D. there in 1723, with a thesis De Diarrhced. He

* " Qualis piirpiiream Auroram cum voce salutans

In coelum celeri fertur alauda fuga : Qualis et astra ferit nervo p^rcussa sagitta,

Gaudet et folios antevolare notos : Talis se sphaerae aetheriae moderamine Gallus

Libravit, superas ausus adire domos. Miramur nova gesta viri, miramur et aeque

Quod levior Gallus fit levitate sua ? "

Dr. G. Thompson married in 1771, Mary, daughter of Wm. and Ann Edmondson, late of Wray, Lanes. See on his life, Mem. Lettsom, i. 10, 21, etc. j MS. Letters of Dr. J. Fothergill, Frds. Ref. Lib. ; MS. Journal of Betty Fothergill ; MS. Registers, Soc. of Frds. ; Gent. Mag. (1803) ; Munk, Roll Roy. Coll. Phys. ; Jos. Spence Hodgson, The Rise of Penketh Preparative Meeting, Penketh School Magazine, 1916-17 ; J. Jenkins, op. cit. p. 585.

XI DR. RUTTY A QUAKER ASCETIC T29

settled at Dublin in the next year, and practised as a physician of reputation in that city for many years, dying unmarried in rooms at the east comer of Boot Lane and St. Mary's Lane, in 1775.

A man of studious habits throughout his whole life, ardent and indefatigable, he wrote much, and his books were solid contributions to knowledge. Fothergill, who corresponded with him, aided him in his literary works. He took especial interest in hydrology, compiling a History of the Mineral Waters of Ireland, published in I757» which displays a mastery of his subject. He enumerates about 125 springs in the country, and of most of these he had made analyses, so far as chemical science then allowed, giving tables of the reactions obtained, and comparing them with some English and foreign waters. Rutty classes the waters as chalybeate, sulphureous, purging, vitriolic, tepid, petrifying and alkaline. He goes on to point out the uses of the several kinds in different diseases, and pleads for the employ- ment of the Irish springs in many cases which resorted to the more fashionable Spas elsewhere. This work was followed by a larger one giving a methodical synopsis of all mineral waters known throughout the world. Rutty also communicated several papers to the Royal Society on waters containing copper, sulphur, vitriol, etc. He wrote, too, a Chronological History of the Weather, Seasons, and Diseases in Dublin for forty years (1770), and a Natural History of the County of Dublin (1772), in which his fondness for natural science is revealed. Lastly, he published in the year of his death an encyclopaedic work, which is still referred to, embodying the researches of many years — Materia Medica, Antiqua et Nova.

Rutty was a Friend by strong conviction, and his History of the Rise and Progress of the Quakers in Ireland (to 1751) is of standard value. Serving as an elder (" a whetstone " to the ministers, so he said), he often paid family visits and spoke in counsel, and he was concerned for the youth and the children, to whose interests he gave up much time amidst his scholarly avocations. Late in

K

130 FOTHERGILL'S MEDICAL FRIENDS chap.

life his convictions deepened under the influence of silent meetings, introspection and mystical literature, and he began to keep at the age of fifty-four years a spiritual diary, which was continued for over twenty years, and was published by his direction after his death. This diary, which was much read amongst Friends a century ago, revealed the writer in his inmost thoughts. Its style is brief, pungent, often epigrammatic ; severe on his own failings, even when these were invisible to his friends : the quaintness of its language provokes a frequent smile — " Oh, thou inflammable jack-straw ! " he addresses himself. The tone of mind can hardly be accounted quite healthy : he was a Quaker ascetic ; his path was shadowed : " this is a life," he writes, " of darkness, ignorance and imperfection " ; Lucifer is " at my right hand." But the book must be read along- side of the testimony of his many friends, who found the busy physician and student a man of mild and guarded temper, full of grace and good works. Dr. Rutty was an early riser and lived simply ; he was very kind to the poor, and records the prayer : " Lord, make them more glorious in my view." ^

Dr. William Hunter

William Hunter, the distinguished anatomist and physician, was nearly contemporary with Fothergill. Both sprung from the north country and became leaders in the medical world in London. Kept out of the fellow-

^ His niece, Catherine Rutty, married in 1753 Thomas Fowler of Melksham, and became the ancestress of a family some of whose members have been distinguished in various lines of service : John Fowler, the inventor of the steam-plough ; Sir R. N. Fowler, Bt., P.O. ; Wm. Fowler, M.P., and others. See A Short Account of the Fowler Family, privately printed. The Diet. Nat. Biog. contains a good notice of Rutty by Dr. Norman Moore ; see also Foth., Works, iii. p. c ; Phil. Trans, xli. 63, xlix. 648, li. 275, 470 ; MS. Letters of Dr. J. Rutty at Fds. Ref. Lib. ; Rutty, A Spiritual Diary and Soliloquies (1776), reprinted in various editions down to 1840 ; it was the subject of a scornful article in the Critical Review, 1777. Boswell, Johnson (ed. 1887), iii. 170. Wesley records in his Journal a visit to the venerable man in 1775, finding him " full of faith and love and patiently waiting till his change should come." See also M. Leadbetter, Biog. Notices of Memb. Soc. Fds. p. 261 ; J. Jenkins, op. cit. p. 93 (2nd).

XI DR. WILLIAM HUNTER 131

ship of the College of Physicians by their Scottish degrees. Hunter and Fothergill were associated in the " revolt " of the licentiates, as they were also in the early Medical Societies of London. The friendship of the two bachelor physicians is attested by a couple of letters from Fother- gill to Hunter which have been preserved. In character, however, they differed much ; for Hunter combined liberal tastes, much cultivation and upright convictions with a temperament jealous of his own rights and prone to take offence. . But he did great work for the science of medicine in his century, laying exact foundations in anatomy and physiology and even in pathology. He was a consummate teacher, and, like his younger brother John Hunter, had much influence on the generation that followed him. Besides his famous brother and his nephew Dr. Matthew Baillie, Hewson, Cruikshank, Aikin and Cleghorn in the British islands, Shippen, Morgan and Logan in America, were among his many pupils.^

Dr. Anthony Fothergill

Childless himself, Fothergill found something of the joy of parentage in gathering young men around him, and his own attitude of scrupulous self-discipline was no bar to the freedom of his intercourse with them. They enjoyed, some of them, his frequent company, and learned of him the high ideals of the medical art, the nobility of the true healer of men, and the scientific spirit which interprets nature without prejudice. They learned, too, that love, as they saw it in the smile of Fothergill, could be the law of life. Lettsom was often at Fothergill's table. Amongst others who met at the same hospitable board were Anthony Fothergill, Percival and Falconer.

Anthony Fothergill belonged to the Westmoreland branch of the family, and was twenty years junior to

^ Dr. W. Hunter (born 1718, died 1783), Physician to the Queen, F.R.S., was the author of the Anatomy of the Human Gravid Uterus (1774), and of other works. See his life by S. F. Simmons, 1783 ; and W. Hunter, Anatomist, Physician, Obstetrician (1901), by the present writer, in which work the two letters from Fothergill are printed.

132 FOTHERGILL'S MEDICAL FRIENDS chap.

John Fothergill, having been born at Sedbergh in 1733. After study at Sedbergh School and Edinburgh, and then at Ley den and Paris, he graduated M.D. at the Scottish capital in 1763 with a thesis on intermittent fever. His elder namesake opened his house in London to him, and proved both then and afterwards his friend and adviser. By his counsel Anthony Fothergill settled at Northampton as a physician in the year 1764. In the unexpected difficulties which he met with in that town John Fothergill wrote to encourage him : " Depend more on propriety of conduct than on any recommendations, though these ought not to be neglected. Have patience, be firm. There is a secret superintending Providence that directs everything for the best. All that we have to do is to act uprightly and to the best of our skill in everything that offers. Difficulties are of use to the prudent."

The prospects at Northampton improved ; Anthony Fothergill became physician to the hospital there, and besides his active medical work pursued scientific re- searches, which were recognised by the fellowship of the Royal Society in 1778. He often consulted John Fother- gill about his cases, and received many medical letters from him. Upon the death of the latter in 1780, Anthony Fothergill essayed to follow him in his house at Harpur Street, but this not answering his wishes he went to Bath, where he acquired much repute and a large income.

An active member of the Medical Society which Lettsom had founded, he contributed papers to it upon influenza, consumption, the treatment of epilepsy, en- larged prostate and gummi rubrum. But his chief work, which he pursued through many years, was the investiga- tion of the causes of sudden death and the means of restoring animation, especially in cases of drowning. An essay on this subject was awarded in 1794 the gold medal of the Royal Humane Society, of which body he was an early member.^

^ A New Inquiry into the Suspension of Vital A ction in Cases of Drowning and Suffocation. Three editions were published. He also WTote on lead poisoning, on the abuse of spirituous liquors, and on the Cheltenham waters.

I

XI DR. PERCIVAL OF MANCHESTER 133

Dr. A. Fothergill retired from practice in 1803 with an ample fortune, and spent some years in Philadelphia, where he continued to make medical observations. Having returned to England, he died at Christchurch, Surrey, in 1813. By his will he requested his friend Lettsom to publish his selected essays, leaving him £1000 for the purpose, but Lettsom's own course was nearly over and the task was never fulfilled. He bequeathed £500 to the Medical Society to establish a Fothergillian Medal. He left also large sums to charitable institutions, and directed that an epitaph should be placed upon his tomb, making a solemn appeal to the passer-by to remember whither he is hastening.^

Dr. Thomas Percival

Dr. Thomas Percival came of a medical family, and was born in 1740 at Warrington, a town with which Fothergill had some connections. Trained at Edinburgh under Cullen and afterwards in London, he took his degree at Leyden, and his wide scholarship and his in- genuity in physical science early obtained for him an introduction to the Royal Society. Percival settled at Manchester, where he had a large practice, and he became one of the most eminent of the physicians to the infirmary. He was an acute medical observer, substituting cautious induction for the speculation hitherto so much in vogue. He wrote on the use of cod liver oil in chronic rheumatism ; of this he gave large doses, with peppermint and carbonate of potash ; and he made experiments with the rectal injection of different gases in putrid fever and other disorders, being convinced of the necessity of correcting putrescence in the pHmcB via. Two volumes of Essays Medical and Experimental bear witness to the freshness and accuracy of his thought. A trained mathematician

^ On Dr. A. Fothergill, see Miink, Roll ; Foth., Works, iii. 159-176 ; Nichols, Lit. Anecd. ix. 211 ; Mem. Lettsom, ii., iii. 270; also his Hints, ii. 297-311 (silhouette portrait) ; Phil. Trans. Ixix. i, a case of St. Vitus' Dance cured by means of shocks from a L&yden Jar ; Ixvi. 587 ; Roy. Soc. Letters and Papers, Decade iv. 404, viii. 122.

134 FOTHERGILL'S MEDICAL FRIENDS chap.

himself, he made a successful effort to reform the bills of mortality and to enumerate the population in his own town. He worked also for the regulation of cotton mills and the institution of fever hospitals.

Percival wrote a famous treatise on Medical Ethics, which was the pioneer and basis of later codes of the sort ; the book was indeed a reflection of his own character and conduct, for he was a pattern of delicacy and rectitude ; governed by a high moral sense, polished and urbane, he was ready to attend to the feelings of the humblest who were around him. A sincere Unitarian, he never intruded his religious views ; a collection of Moral Tales from his pen was thought worthy of translation into French and German. In his earlier life he had known Voltaire and a circle of brilliant French writers at Paris, of whose Royal Medical Society he became a Foreign Associate. His own literary tastes were shown by his presidency for twenty years of the Manchester Literary and Philosophical Society, which was set up by himself and others in 1781.

Delicate health, evidenced in part by a weakness of the eyes, forbade long life to Percival ; he died in 1804. His portrait shows a countenance marked by thought and refinement. The encomium of his kinsman, the eloquent Magee, afterwards archbishop of Dublin, may be quoted : " He was an author without vanity, a philosopher without pride, a scholar without pedantry, a student without seclusion, a moralist without morose- ness, a patriot without f

Related documents

• A history of Pendleton County, West Virginia#660306
• History of York County Pennsylvania From the Earliest Time to the Present#660307
• History of Edgefield County from the earliest settlement to 1897#660308
• History of Guernsey County, Ohio#660310
• The story of Georgia and the Georgia people, 1732 to 1860#660311