Ladies & Gentlemen, friends all, it was 2 years ago when I first suggested to Roderick Kesson that I had an idea for this year's meeting - and he accepted with an alacrity which should have put me on my guard. My original idea, rather unfocussed, was that we might take a brief look at some aspect or other of the history of medicine. By degrees it came to me that it would be interesting, and to the point, to take Charterhouse itself, and Old Carthusian doctors, as my central theme and starting point. When I aired the suggestion at last year's meeting it seemed to go down well and some of you offered practical help so my course was firmly set. The difficulty then was to accumulate enough material to fill even 10 minutes, let alone 60, without mounting a major exercise in historical research and without reducing the proceedings to a mere dull parade of names and dates.

An expert is defined as follows: an ex is a has-been and a spurt is a drip under pressure. I am no expert. I could not have got very far without assistance and I must here acknowledge in particular the contributions of John Struthers and Jonathan Hunt who will speak later and of Ann Wheeler the school librarian who very kindly looked out a pile of references for me from Celebrated Carthusians, Carthusian Worthies and The School Register at a rather crucial stage 2 months ago when I was bogged down with other commitments and seriously short of material.

I must also acknowledge the use I have made of Anthony Quick's History of the School and of an earlier book, Bob Arrowsmith's Charterhouse Miscellany, with both of which I am sure some of you are familiar, but not so familiar I hope as to spot every last borrowing! As a last resort I had recourse to the Dictionary of National Biography, a fascinating collection between whose covers can be found proof positive of the remark, de mortuis nil nisi bunkum! For background material I have used Encyclopaedia Britannica and a number of books on aspects of medical history which have accumulated on my shelves over the years. I see my wife smiling wanly there; I am afraid she is thinking to herself how far that accumulation has extended beyond the shelves originally allotted to it.

Thanks are also due to the Wellcome Foundation for the illustrations, with acknowledgement of copyright.

I am going to take 2 medical OC's from the 18^th century, with one other who is interesting and illuminating although not medically qualified, and 4 from the 19^th century and to look at their lives and times and, just a little, at medical events in the school itself over its first 300 years or so. I will then hand over to Jonathan who will describe some of his father's experiences earlier this century and John who will also give us some family history but then bring us back to the 1950's and his own early years in practice. I shall then round things off and we can all have some lunch!

I have two small apologies. First of all I think I originally suggested, to Rod at least, that I would try to involve current members of the school in our proceedings. In the event that proved an elaboration too far. Secondly, I am aware that this is a medical society in the broad sense and that a few of our members are dentists not doctors. I am very sorry to say that although I kept my eyes open I discovered nothing whatsoever in the course of my researches about Carthusian dentistry!

As a general rule it is a good idea to begin at the beginning, but it is said that rules were made for the obedience of fools and the guidance of wise men, so I am going to begin a little earlier. When I set out to prepare this talk I knew I needed some famous OC doctors and I have great faith in the Encyclopaedia Britannica so I thought I would start there. I have it on CD-ROM so I ran a Boolean search on Charterhouse and Medicine and I came up with a few subjects, some relevant, some not but one in particular who caught my fancy.

As I am sure none of you will need to be told he was not educated at our school; it was not founded until more than 60 years after his death. He was a real Carthusian, a Carthusian friar. He was admitted to the order after taking his degree at Oxford. After a few years he was 'dispensed from religion' to act as suffragan bishop of Chichester, so it appears that you did not have to be any more religious to win a bishopric then than you do now. He never filled the office, and in 1529 he was freed from his monastic vows, being 'unable to endure the hardships of religiosity'. In fairness, the Carthusians were a particularly strict order.

For some years after that he travelled around Europe and for part of that time he appears to have been engaged in a little irregular diplomacy, collecting information for that devious statesman Thomas Cromwell, but by 1536 he was studying and practising medicine in Glasgow. He put up with Glasgow for 2 years then about 1538 he set off on his travels again and this time he got as far as Jerusalem. Around 1542 he completed his First Book of the Introduction of Knowledge, in prose and rhyme, which is said to rank as the earliest continental guidebook.

He seems to have been one of those clerics after the style of his near-contemporary Erasmus who broke free of his order to enjoy a liberated, cosmopolitan, slightly down at heel lifestyle, but holy church was not to be mocked and eventually he ran out of luck. Towards the end of his life he was sent to the Fleet prison for keeping loose women in his quarters at Winchester and there he died: not just one loose woman, loose women! He does not really belong in our story but he was so much fun I could not bear to leave him out.

Thomas Sutton died in 1611 at the age of 79. He was notoriously rich. He was known in his lifetime as 'Riche Sutton' or simply 'Crœsus'. He made his money by lending money, on the grand scale, in an age when money lending was still regarded as slightly grubby. Today we might call him a private financier. As we know, and to our lasting benefit, he left much the greater part of his fortune for the foundation of a school and hospital. Having seen off a challenge from Sutton's nephew who was his legal heir his executors and the governors appointed under his will made remarkable speed and both school and hospital opened their doors just 3 years later in the autumn of 1614. Those of us who are GP's could do with their skills today as we struggle to establish Primary Care Groups; we could also do with the money.

Amongst the many appointments made by the governors in the early years was that of physician, to attend to both the scholars and the brothers. Amongst their regulations was a piece of epidemiological good sense: in time of plague town boys were to be excluded. Those were the boys taken into the schoolmaster's and usher's own houses and taught alongside the foundation scholars as a means to supplement the masters' incomes. The scholars were either to be sent into the country, or if they had nowhere to go, to be kept in the school with the gates firmly closed. In 1665, the year of the great plague, there was no annual governors meeting so it seems likely that the regulation was adhered to and that the gates were indeed closed.

Early 17^th century medical practice had more in common with the practice of 200, or even 500 years earlier than it does with today's. The old dogmas of Galen, the doctrine of humours and so forth, were on the wane but they certainly had not vanished. Sound knowledge was scanty, treatment at best empirical, at worst traditional and probably useless if not actively harmful. That situation scarcely changed for at least 250 years and there are some who might say it has not changed much even now! 17^th century London was rife with medical quacks but reading the descriptions of those quacks and their treatments it is often hard to draw a distinction between them and the regular doctors.

Nonetheless, the spirits of science and of innovation were on the move. The first documented caesarean section on a living woman was performed in 1610; although she died 25 days later. In 1628 William Harvey published his classic book De Motu Cordis, in which he described the circulation of the blood, although he did not know why it circulated and could only speculate how it found its way from the arteries to the veins. That same year Marcello Malpighi was born in Bologna. In 1661, using a microscope, Malpighi identified and described the pulmonary and capillary network connecting small arteries with small veins. Later in the century Robert Boyle, an Eton man I am afraid, showed that air is essential to animal life and finally in 1667 Richard Lower an assistant to Thomas Willis, of the circle of Willis, fitted the final piece in that particular jigsaw when he traced the interaction between air and blood in the pulmonary circulation.

It was an exciting century, dangerous too: the century of the Civil War, the Commonwealth and the Restoration, of the Plague, of the Great Fire of London, which missed Charterhouse by quite a narrow margin, of Milton, Dryden, Bunyan and Pepys, of the early experimental natural scientists and above all of Isaac Newton. The Royal Society was founded in 1660, the Royal Society of London for the Promotion of Natural Knowledge, the oldest scientific society in Great Britain and one of the oldest in Europe.

Our first Carthusian doctor is Henry Levett, born in 1668. I doubt whether he was literally the first but he is the first I could find and he makes a good starting point because he was both a distinguished doctor and played a significant part in the early history of the school. He was educated at Charterhouse and went up to Oxford, to Magdalen College, in 1686 aged 17 or 18. He graduated MB in 1695 and MD in 1699. He settled in London where he was elected physician to St. Bartholomew's Hospital in 1707 and became physician to Charterhouse in 1713. Most of us will know, some of us may not, that St. Bartholomew's is no more than a quarter of a mile from Charterhouse across Smithfield market. Levett was clearly an early pioneer of the Charterhouse - Barts. connection which has existed ever since, although I am afraid that I myself did not follow the tradition.

In 1710 he wrote a letter, later published, on the treatment of smallpox and, very much a man of his age, recommended the use of cathartics, ie. purgatives. The letter was in Latin and we have to remind ourselves that Latin was still a language of communication between educated men. He rebuilt the physician's house at his own expense, the house beside and extending over the great gate in Charterhouse Square, and lived there until his death. The oak carving and panelling he put up is still in place. He became censor then treasurer to the Royal College of Physicians. He died in 1725 and his tomb is in the chapel at Charterhouse. His widow remarried the then headmaster, Andrew Tooke, so altogether he and his seem to have been very much of the Carthusian family.

PETER TEMPLEMAN 1711 ~ 1769

Our next subject is Peter Templeman, born in 1711. He was one of the town boys, not a foundation scholar. He went up to Trinity College Cambridge where he took a Bachelor's degree then went to study medicine at the University of Leyden. He had what are comfortably called private means and he took a fairly leisurely course through life. He never developed a large practice. He had interests in literature and eventually, in 1758, he was appointed Keeper of the Reading Room at the British Museum. Nonetheless he published some medical papers and including one on a 'Polypus of the Heart' and another on a 'Scirrhous Tumour of the Uterus'. I suppose the tumour was most probably just that. I wonder what the polypus was, an atrial myxoma perhaps? His interests were clearly wide-ranging because towards the end of his life, in 1766 he published a paper entitled, 'Practical Observations on the Culture of Lucerne, Turnips, Burnet, Timothy Grass and Fowl Meadow Grass.' So it seems as though he also interested himself in the agricultural revolution. He was an asthmatic and as treatment he finally resorted to something described as Bishop Berkeley's Tar Water. He died in 1769.

A little later in the 18^th century another Carthusian had some small medical impact, at least in his own locality, although he was not himself a doctor. William Clerke, Sir William Clerke, became rector of Bury in Lancashire in 1778. 'He paid much attention to the physical health of his parishioners and on the occasion of an outbreak of fever he issued in 1790 Thoughts upon the Means of Preserving the Health of the Poor by the Prevention and Suppression of Epidemic Fever. He vaccinated the children of the poor even going to Rochdale once a week for a considerable time to perform the same operation.' According to my road atlas that is only about 4 miles down the B6222 but I suppose it was a moderate little journey if he went on horseback and a fair step if he walked. Nonetheless I think whoever wrote his obituary was over-praising him there, just a little.

To revise some very well known medical history, inoculation against smallpox was popularised in England in 1721-22 by Lady Mary Wortley Montagu, who observed the practice during her travels in Turkey. It entails infecting the subject with smallpox itself using material from someone with a mild attack of the disease and of course it carries a risk of producing a serious infection, precisely what it aims to prevent. The next step was taken by Edward Jenner, a country practitioner, a pupil of John Hunter who inspired him with the wonderful advice, "Why speculate, why not try the experiment?". Jenner began inoculations with material from cowpox, the bovine form of the disease, in 1796. He vaccinated a young lad with material harvested from a milkmaid with cowpox then, after 6 weeks he attempted to infect the lad with smallpox, without success. Clearly there were no ethical committees to impede progress in those days. He first published his work, privately, in 1798. Vaccination quickly became very popular and Clerke was one of the many who picked up the new idea and ran with it so that within a very few years smallpox was virtually eradicated, in this country at least. He probably did more good in that way than many doctors.

I am afraid his story has an unhappy ending. 'He was fond of agricultural enterprises and dealt extensively in corn, malt and lime, borrowing largely in the course of his undertakings. He was a simple-minded man, was fleeced by his subordinates and at last his living was sequestered for the benefit of his creditors. He died in 1818 in the Fleet prison where he had been incarcerated for debt.' the second of our subjects to end his days there.

The background to all of this was another turbulent century. The Hanoverians, the Old Pretender, Bonnie Prince Charlie, Handel, Swift, Fielding, Gay, Pope, Johnson and Boswell, the steam engine, the industrial revolution, the agricultural revolution, Robert Walpole, the first British Prime Minister, the Seven Years' War and poor Admiral Byng, the Anglo-Dutch Wars, George III and his breakdown due to porphyria, the Boston Tea-Party and the loss of the American colonies, the French Revolution, Napoleon and the outbreak of the French Wars.

Conditions for the Charterhouse boys in the early part of the 19^th century are described by Anthony Quick as barbarous, anarchic and Spartan. By inference they were no better than those of the century before or the century before that, and possibly worse. Life seems to have been uncomfortable for the brothers too and the ancient quarter of London in which the foundation stood had become dilapidated and insanitary. The eventual move to Godalming was undoubtedly an enormous change for the better but of course that did not take place until 1872. There were no proper baths. The more hygienically inclined boys went to one of the local public bathhouses on Saturday afternoons.

In 1821 there was an epidemic of scarlatina, presumed due to overcrowding in the dormitories and about this time also one of the smaller boys was crushed to death in a playground maul. Writing his memoirs, an unhappy one-time Carthusian recalls the school of those days as 'that horrible prison'. He was taken home ill after being dropped whilst being tossed in a blanket and after his recovery 'sent to that seat of sound learning and religious education called Eton.' Dark days indeed!

Nonetheless despite harsh conditions and very rudimentary medical arrangements serious illness seems to have been uncommon. G.S. Davies in his Charterhouse in London recalls, 'Our Medical Officer, Dr. John Miles, a man whose knowledge of human nature perhaps was in advance of his medical science. He had in his repertoire two main remedies. If he suspected a boy of wishing to sham he gave him a black draught; if he thought he was really unwell he gave him brown mixture. The would-be shammer feared the black, the ailing boy feared the brown, so on the whole the sick list was kept fairly free.' Davies adds that, 'There was a third remedy known as white mixture but I have no idea what class of crime this was intended to meet.'

Perhaps he is being a little hard on poor Dr. Miles who may well have been wise enough to understand both human nature, or at least the nature of schoolboys, and the limited value of the medical treatment of his day. In a description of the outpatients department of St. Bartholomew's Hospital in 1869 we read, '120 patients were seen by the physician and dismissed in an hour and ten minutes, or at the rate of 35 seconds each. Each patient received a doubtful dose of physic ordered almost at random and poured out of a huge brown jug.' That certainly puts in perspective some of my own repeated grumbles about 20 patient NHS surgeries and 7 minute appointments.

Not that illness seems to have been any better tolerated in Godalming 50 years later. 'More dreaded than any master by the boys of Saunderites was their Matron, Miss Attfield. Her inflexible resolution was reinforced by her appearance, as of a scorbutic martello tower. Whether your head ached, for which ailment proof was required, your hand bled or your ankle was sprained, there was no reasoning with the Attfield until you had adsorbed a tumbler of that powerful drench known as house mixture.' Charterhouse boys remained a hardy breed a generation later. After the Verite fire of 1918, a serious fire which largely destroyed the house, many Verites spent a good part of the summer quarter sleeping in a marquee. In that accommodation they shrugged of the epidemic of influenza which swept the country. This was no ordinary epidemic either, nor ordinary 'flu'. It was a premonitory ripple of the great pandemic, described by Richard Collier in his book, 'The Plague of the Spanish Lady', which swept the world in 1918-19 at the close of the Great War, killing some 21 million people, at least as many as had died because of the war itself.

It is that sort of 'flu' of course which excites the authorities world wide to commission vaccine and persuades the citizens of Hong Kong to slaughter all their chickens, not the sort that brings a certain type of patient shuffling into our surgeries looking for free Paracetamol and a sick line, which is seldom 'flu' at all. When I was a medical student in the 1970's I remember visiting the old Friern Hospital, Colney Hatch asylum, with some colleagues and Dr. Richard Hunter who was medical director there showing us some very elderly patients with encephalitis lethargica, a condition akin to parkinsonism, produced by damage to their basal ganglia by that 'flu' virus all those years before. Carthusians, living on this healthy hilltop seem to have escaped largely unscathed.

I am running ahead. Although understanding of the workings of the human body and knowledge of its ills improved through the 17^th & 18^th centuries there was little matching improvement in medical treatment. At a practical level the medicine of early 19^th century Europe was arguably no more sophisticated or effective than that of the ancient Greeks or Egyptians. James Parkinson described his 'Shaking Palsy' in 1817 and described it with great precision but all he could suggest by way of treatment was bleeding, purging and blistering. In 1819 John Bostock described a commoner if less serious affliction, hay fever; so much for this being a modern condition due to diesel particulates or whatever. He was scientist enough to notice that a patient who spent 6 weeks confined to his house one summer had less trouble than in previous years, but again, he could suggest no useful treatment. It was the century of eponymous diseases, Hodgkin described his in 1832 although no-one paid much attention at first, but many of the juiciest came later and owe their names to French and German doctors, and to the Americans.

As late as 1824, according to one of my sources, of the 100's of drugs listed in the Pharmacopœia of the Royal College of Physicians, only opium was of much benefit, and opium had been known in ancient Rome and in Europe since the 16^th century. Perhaps that view is a little extreme because digitalis and quinine were both on the list too, but their properties were poorly understood and their use unfocussed. There were various iron preparations, used as tonics, whose use was equally unfocussed because iron deficiency anæmia was not yet properly recognised for what it was. There were also a great number of purges. Purging was very widely used, quite uselessly of course, both as a treatment in its own right and as a preliminary to almost any other treatment. Doubtless the purges were effective as such, it is rather easy to tell, and there is some satisfaction for both parties to the transaction, doctor and patient, in achieving a predictable effect. Then as now, patients knew what they expected of their doctors and were disappointed and affronted if they did not get it. Purging, or bleeding, or both, were part of the bargain, just like antibiotics, or linctuses, or both for colds today, and in just the same way if you did not get them you were being short-changed and your doctor's competence and his concern for your well-being were suspect.

Surgery, some surgery at least, was better advanced and more effective. Until the mid-19^th century it was still enormously limited by the absence of effective anæsthesia or of any understanding of sepsis although it is remarkable what surgeons achieved, and what their patients endured, without. There was an 18^th century word, 'bottom' which meant that all the discomforts and pains of life were to be born cheerfully. Bottom was certainly needed to bear the pain and shock of a surgical operation. Nonetheless patients bore them, and they benefited. We may think of audit as a recent innovation but tables of cases and outcomes are nothing new. In the Annual Report of the Liverpool Royal Infirmary for 1836 we read: 'amputations of the upper extremity, admitted 20, cured 19, died 1; amputations of the lower extremity, including 3 patients who lost both legs, admitted 23, cured 21, died 2; tumours removed, including breast tumours, admitted 10, cured 8, died 2,' and so on.

What is noteworthy here also, besides the surprisingly good results, is the small number of cases and the limited range of procedures. However much bottom the patient could muster, many operations would have been unthinkable without anæsthesia and doubtless patients were only selected who seemed likely to do well. The rest would simply have been treated expectantly as we still say when we mean we can do nothing, and those in extremis given laudanum until they succumbed. Statistics which tell only half the story are not a new phenomenon either. For myself, I shall believe evidence based medicine when I see evidence based evidence!

Perhaps the limitations were no bad thing. When surgeons were eventually set free to develop their craft by the development of general anæsthesia after 1846, by Joseph Lister's introduction of antisepsis in 1865 and by the later adoption of proper aseptic sterile procedures towards the end of the century, they quickly developed many operations whose value was at best questionable. Organs were removed wholesale according to the doctrine of focal sepsis, various assaults were mounted, on the female reproductive tract in particular, as would-be cures for nervous diseases. The wandering womb which the Greeks used to blame for female nervous ailments was finally secured in place with surgical sutures, if it was not removed altogether. Fairness compels me to add that my copy of McNaughton Jones' Diseases of Women of 1891 informs its readers in magisterial tones that, 'The operation of clitoridectomy for various disorders of the nervous system is not an accepted operation in this country.' nonetheless, 'To a man with a hammer, everything looks like a nail!' and the surgeons of the later 19^th and early 20^th centuries certainly found themselves with a hammer.

The Carthusian medical men who achieved most distinction in the 19^th century were physicians and obstetricians rather than surgeons. Obstetrics in those days was a medical speciality, not surgical, and the better sort of obstetrician became a fellow of the Royal College of Physicians.

Benjamin Babington was born in 1794 at Guy's Hospital where his father, also a doctor, was resident apothecary at the time; so the problem of combining a training post, marriage and family life is clearly nothing new. On leaving Charterhouse he joined the navy as a midshipman and saw action but a few years later he entered the Indian Civil Service. Whilst in India he made a study of Indian languages and cultures and eventually became an orientalist of some distinction, but he found the climate too trying and after a time he returned home to become what we should call a mature student of medicine at his father's old hospital, Guy's, and in Cambridge. He took his MD in 1830 aged 36. He became interested in 'animal chemistry', chemical pathology, and assisted Sir Astley Cooper, Dr. Richard Bright, of Bright's disease and others in the analysis of 'morbid products'.

Astley Cooper was reputed to earn £15,000 a year. He was given his knighthood by George IV for removing a sebaceous cyst from the King's scalp, without benefit of anæsthetic of course. 'What do you call the tumour?' asked the King after it was all over. 'A steatoma Sire.' replied Astley Cooper, using the old Latin name. 'Then I hope it will stay at home and trouble me no more!' said the King. We are told that Bright excelled at making meticulous clinical observations and correlating them with careful post mortem examinations, which probably says a good deal about the practical value of his treatments.

In 1840 Babington was appointed physician to Charterhouse. In 1843 he took out a patent for pens and in 1850 another for preventing incrustations of boilers. Sadly, for those like myself who enjoy the bizarre, both appear entirely sane and practical. They entail the principle of electrolytic protection; a piece of zinc is attached to the pen nib to prevent it from corroding in the ink and zinc sheets are similarly fixed inside the boiler. Whether either was put to practical use I do not know. Babington wrote two papers on the blood, in one of which he described the 'fat constantly present in the serum', so he was also an early lipidologist. He founded and was for some years president of the Epidemiological Society and he published a number of medical books and papers on epidemiological and other topics. He also found time to translate many oriental works. He seems to have been exceptionally able and hard-working in a quiet way but he was good at covering his traces because he is described as retiring and unambitious. Ambition can be a great waste of energy; perhaps he was wise enough to realise that. He died in 1866.

A doctor in a very different mould was Arthur Farre, born in 1811, son of Dr. John Richard Farre of Charterhouse Square and younger brother of Frederick John Farre, also a Carthusian, in his time head boy of the school, and also a doctor. Dr. John Farre is described as a West Indian and whether that implies that he was a gentleman of colour I do not know. Preoccupation with such matters seems peculiar to the present century and to the post-war generation. It did not exist in earlier times and thankfully it now seems to be fading. Both brothers went up to Cambridge, Arthur to Caius College, Frederick to St. John's. After graduating both returned to Saint Bartholomew's where they held various posts. Frederick remained a Barts. man although later he also held an appointment to the Royal London Ophthalmic Hospital. In due course he became medical officer to the School. In 1841 after gaining his MD Arthur moved on to King's College where he was appointed professor of obstetric medicine and physician-accoucheur. He became a successful, fashionable obstetrician, attended the Princess of Wales and other members of the Royal Family and was made physician extraordinary to the Queen.

In her biography of her grandfather, Sir James Reid, Queen Victoria's court physician, Michaela Reid describes the ranking of the Queen's medical establishment. Physicians and Surgeons Extraordinary like Arthur Farre were on probation. If they were lucky, in due course they might be appointed to one of the senior posts of Physician or Surgeon in Ordinary; there were usually about 3 of each. These were all consultants, specialists. Below them came the apothecaries to the person and to the household who were effectively GP's.

The 19^th century did not begin well for royal obstetrics and certainly royal obstetricians had the fate of Europe in their hands on more than one occasion. George IV's beloved daughter, Princess Charlotte Augusta, died in childbirth, probably of a post-partum haemorrhage, in 1817. The child, a boy, was stillborn. Had he lived, and outlived his father, he would have succeeded to the throne in due course. Had the Princess survived the stillbirth she might have born more children. Either way we might never have had Queen Victoria, nor any of her successors. The Princess's death triggered widespread national mourning; reading the contemporary descriptions this sounds very much like the upset which followed the death of Diana Princess of Wales last year. Her obstetrician, Sir Richard Croft, who seems to have done all that could reasonably be expected of him, shot himself 3 months later, by his side a copy of Love's Labour Lost, open at the page on which appears the line 'God save you! Where's the Princess?'. The episode was later described as a triple obstetric tragedy.

Things went much better at the birth of the Duke of Kent's daughter Victoria on 24^th May 1819. Dr. Wilson, her father's personal physician, was considered to have managed the pregnancy to perfection, probably because he did little to interfere with the midwife, Madame Siebold. She was clearly a capable lady and much in demand because she then hurried back to Germany to deliver Victoria's cousin and future husband Prince Albert on 26^th August of the same year.

Sadly there was no-one to keep Dr. Wilson in check when the Duke of Kent caught what seems initially to have been nothing worse than a heavy cold whilst spending the winter in Sidmouth in 1820. He was cupped and bled and leeches were applied until he was covered in blisters and probably dangerously anaemic. It is calculated from Dr. Wilson's records that he was let some 6 pints of blood in the space of a week. Then Dr. Manton, one of the royal physician's arrived from London and bled him some more. He died within a fortnight.

Later in the century there was another royal obstetric excitement when Queen Victoria herself permitted Dr. John Snow to give her Chloroform for the birth of her 8^th child, Prince Leopold, in 1853. This was the same John Snow who a few years earlier surmised the fæcal-oral transmission of cholera and put an end to the Broad Street epidemic by having the handle taken off the pump. The Vibrio was not discovered until the 1880's, by Koch, but the Reverend Sydney Smith had the gist of it when he wrote, about the time of the epidemic, 'He who drinks a tumbler of London water has literally in his stomach more animated beings than there are men, women and children on the face of the globe!'.

Chloroform anæsthesia was a hazardous undertaking as we now recognise. Chloroform can trigger fatal cardiac arrhythmias and cause delayed fatalities through necrosis and fatty degeneration of the liver. Many other organic solvents have similar properties, something which glue sniffers occasionally discover to their cost. As its dangers came to be realised later in the century it was largely superseded by Ether. Ignorance is bliss and Victoria was delighted by the effects, so delighted that she had it again for the birth of her 9^th and last child, Princess Beatrice in 1857. How different history might have been again had things gone wrong. Snow was fortunate to go down as one of the century's heroes, not with poor Richard Croft as one of its arch-villains.

The obstetrician in attendance at the birth of all Victoria's children was Sir Charles Locock. Arthur Farre succeeded him as President of the Obstetric Society of London in 1875. He died in 1887.

We have had one gentleman amateur and one successful society practitioner. Our next Victorian doctor became a pillar of the medical establishment. Sir George Paget, born in 1809, was sent to Charterhouse in 1824, aged 15, where he made his mark as a mathematician although the tradition of the school then under Dr. John Russell was largely classical. He went up to Cambridge, to Gonville & Caius College, where he took his degree and then carried on to study medicine. He completed his studies at St. Bartholomew's Hospital and in Paris and graduated MB in 1836 and MD in 1838. That same year he was elected a fellow of the Royal College of Physicians and became a physician to Addenbrooke's Hospital in Cambridge. At first he was a fellow of Caius College where he became bursar. He vacated his fellowship on his marriage, as I believe one still had to in those days.

He was a good teacher. 'His lectures were excellent, though he had the disadvantage of having often to lecture to students not sufficiently advanced in their studies to profit to the full from his instruction.' I seem to recall that some of my lecturers had the same problem. In 1842 he persuaded the University to institute bedside examinations for its medical degrees; the first clinical examinations to be held in the United Kingdom. Perhaps the students used the wooden stethoscope which Laënnec invented about 1819 to save himself from the embarrassment of laying his ear against a young lady's bosom to auscultate her chest; not much of a Frenchman I feel. He appears to have had a particular interest in neurology and published a number of neurological cases, including one in 1860 in the BMJ, 'A Case of Epilepsy with some Uncommon Symptoms - being peculiar automatic outbursts of laughter.'

The patient was an agricultural labourer, aged 20 and unmarried, living with his parents at Meldreth which is a little village about 8 miles south of Cambridge down the A10. He was under Paget's care at Addenbrooke's as an inpatient and as an outpatient, for about 2 years from 1856 and was then readmitted in 1860 shortly before the paper was published. 'He had much of the ordinary appearance of an agricultural labourer: a robust figure, a head not ill-shaped but the occiput and the nucha were large. His features were regular but had a dullish, grave cast. His intelligence was of an ordinary kind without the smallest pretensions to brightness. From his looks one would infer him to be as free from nervous excitability as his class commonly are.' I did my first house job at Addenbrooke's. Cambridge patients do not change much, nor do Addenbrooke's physicians.

He was admitted with a history of frequent, generalised epileptic convulsions but interspersed with bouts of sudden, spontaneous laughter. He could have as many as 30 of these in 24 hours although usually not more than 3 or 4. Sometimes when he laughed he would even dance a happy little jig, 'lifting his feet high as Irishmen are represented dancing at a wake'. When he recovered he could not say what had made him laugh nor could he recall feeling at all amused.

Paget goes on to record his patient's progress at great length and to describe several other cases exhibiting similar symptoms, some from the literature and one which he learnt of recently in the course of a conversation with Dr. Brown-Séquard. He suggests what may seem obvious to us now but may have been less obvious then: that the laughing attacks are a form of incomplete convulsion. He deduces from the apparent naturalness of the laughter but its complete dissociation from any conscious or emotional component that laughter arises in a part of the brain distinct from those concerned with consciousness. He guesses at the medulla. Whether laughter does indeed arise in the medulla I am not neurologist enough to know. The idea that neurological functions might be anatomically localised in the brain was at the leading edge at that time. Dr. John Hughlings Jackson in London first described what later became known as Jacksonian epilepsy in 1863 and confirmed the existence of Broca's area a few years later.

Alas, neurological insight did not lead on to effective treatment. I believe that is still a common problem. Leeches, ammonia and valerian and 'the most careful regulation of his bowels' all failed. Morphine elixir and chloric ether sedated him and reduced the violence of the generalised convulsions, but only temporarily. Paget noticed that the laughing attacks became less frequent when he had quinsy and could not eat, so he tried a starvation diet but this had little effect either.

By now the patient's character had changed. After his discharge home 'His mother reported that he got beer when he could and that its effects were exceedingly prejudicial. A pint of it would make him nearly mad. He seldom attended outpatients: the village carrier refused to convey him because his strange laughter frightened the other passengers.' Paget then lost sight of him until he was readmitted in 1860. After a year's remission he was having frequent fits again, both generalised convulsions and the laughter attacks. He was treated with blisters, belladonna plasters, valerianate of zinc and henbane and seemed to improve. There the story ends.

Paget went on from strength to strength; Linacre Lecturer at St. John's College in 1851, President of the Cambridge Philosophical Society in 1855, a member of the Council of the Senate in 1856. In 1863 he was chosen to represent the University on the General Council of Medical Education and Registration, the forerunner of the General Medical Council. He was elected president of the Council in 1869 and re-elected in 1874. Altogether his is the story of a steady, determined climb all the way to the top. In 1872 there came the cherry on the cake; he was appointed to the chair of Regius Professor of Physic at Cambridge which he held until his death, in 1892 from influenza. His bust, in marble, is in Addenbrooke's Hospital.

I will end the 19^th century, and my talk, with a maverick, Thomas Lovell Beddoes. He was the son of Thomas Beddoes, a distinguished physician who at the end of the 18^th century attempted to found an institute of pneumatic medicine in Clifton, near Bristol. Precisely what that entailed I have been unable to discover but he certainly managed to engage James Watt to construct his apparatus, the young Humphrey Davy to assist and Josiah Wedgwood to contribute £1,000 to the cost of it all. He set Davy on the road to fame but the institute itself failed and he repaired to London where his son, our subject, Thomas jnr. was born in 1803; in 1809 Thomas snr. died.

Any of you who follow the Journal of the Royal Society of Medicine may have noticed a short article in the latest edition, in the historical section, on Georgiana, 5^th Duchess of Devonshire, which describes the dealings between the Duchess and Thomas Beddoes snr. concerning his institute in the last years of the 18^th century. The point of greatest interest for the writer of the article is that Georgiana was a Spencer, a distant ancestor of Lady Diana. She took a keen interest in Beddoes' work and it may even be that is was her encouragement which persuaded him to press ahead. Later he recruited her help in an attempt to gain the support of the Royal Society, but to no avail. In his earlier life he had won himself a reputation as an outspoken radical and he appears to have remained in bad odour with the establishment, or at least with Sir Joseph Banks, the President of the Royal Society to whom the Duchess twice wrote on his behalf, without success. He must have been in very bad odour indeed if two begging letters from a prominent, influential, attractive Duchess both received dusty answers. Sir Joseph raised some scientific objections too but the prime source of his unhelpfulness appears to have been a strong personal dislike for Beddoes himself. As we shall shortly learn his son inherited his careless talent for making enemies who mattered.

Thomas jnr. entered Charterhouse in 1817 and during his time there 'he distinguished himself by his mischievous deeds of daring and by the originality of his behaviour'. I had some contemporaries here like that, some of them were expelled; many of them now seem to be lawyers and accountants, far better off than I am and so straight-laced it is indecent.

Beddoes went up to Pembroke College Oxford where he was described as 'eccentric and rebellious, priding himself on his democratic sentiments which he preserved throughout his life': like father, like son. In 1822 aged 19 he published a gothic novel, The Bride's Tragedy, which was a considerable hit. In 1824 he is describe as 'innocent, gay, with a gibe always on his tongue, a mischievous eye and locks curling like a hyacinth'. Sadly, despite undoubted literary talents he never repeated his early triumph. After graduating in 1825 he went to the University of Göttingen to study medicine and whilst there he wrote his only other considerable work, a play partly in verse, Death's Jest Book, also known as The Fool's Tragedy, which he repeatedly revised ever afterwards and which was never published in his lifetime.

Here are a few lines, a few of the more coherent;

And some more;

I am none too keen on psychoanalytic biography, all the same I wonder whether Beddoes is telling us something about himself there.

He had always been a political radical and he became mixed up in German politics. He took his medical degree in Würzburg in Bavaria in 1832 but later in the 1830's he was expelled from Bavaria after too openly expressing his sympathies with the Poles, some of whom were then under the Prussian jackboot; Poland was partitioned at the time and the rest were under either Austrian or Russian jackboots. Beddoes responded by referring to the King of Bavaria in a pamphlet as "that ingenious jackanapes". This was not mad King Ludwig who built the palaces and bankrolled Wagner, it was his grandfather Louis I. He removed to Zürich where in 1839 he came perilously close to being shot by a reactionary mob. As the DNB restrainedly puts it, 'His democratic opinions openly expressed made him unpopular.'

After that he wandered back and forth across middle Europe, he returned to Britain for a little while then went abroad once more. His behaviour whilst in Britain was remarked as odd; one evening he set off expressing the intention of setting fire to Drury Lane Theatre with a lighted £5.00 note. He died in 1849 in Bâle. The DNB hints darkly that 'the circumstances which surrounded his death were mysterious and not made known to the public.' The official story is that he broke his left leg, gangrene set in and he required an amputation, he appeared to be doing well but he was found dead in bed one morning. The true account, as published in Celebrated Carthusians, is sadder and more illuminating. On his return to the continent he formed a friendship with a baker named Degen, 'a nice-looking young man, 19 years of age. Degen seems to have exercised a strange fascination for the 44 year old Beddoes who on one occasion hired a theatre in Zurich for a night solely in order that his protégé whom he had persuaded to become an actor should play the part of Hotspur on the stage'.

They fell out and Beddoes, left alone in his hotel, inflicted a severe injury on his left leg with a razor. He was taken to hospital where he repeatedly tore off his bandages, attempting to bleed himself to death. Gangrene developed and he did indeed require a below knee amputation. Then Degen reappeared and all was sweetness and light once more, for a little while, but shortly after leaving hospital Beddoes bought poison and one evening soon afterwards his Doctor found him 'beyond human aid, lying insensible on his back'. On his chest was a letter to a friend in England beginning, 'My dear Philips, I am food for what I am good for, worms,' and concluding, 'I ought to have been, among a variety of other things, a good poet. Life was too great a bore on one peg, and that a bad one.' He died the same night. He seems to have been an exceptionally able man who led a life of blighted promise, and like so many such men he was himself the source of both promise and blight.

I think you will gather that I am rather taken by Beddoes. When I was researching him I thought I would have a look on the Internet because he is a significant literary figure in a small way; he is certainly in the Encyclopædia Britannica. I was really hoping I might find a portrait. What I found instead was a personal web site created by a lady called Tara in the USA on which she tells us how much she loves his work, which she stumbled across by accident, and on which she publishes almost his entire output, alongside a thumbnail description of herself and a selection of her own vegan recipes. It is wonderfully encouraging that for all his tangled, unfulfilled life Beddoes should still excite interest and spontaneous attraction over a century after his death. And as a spin-off I have some very nice recipes for nut cutlets.

Eric Webb
Milton Keynes
08 March 1998