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Doctors at Court MAY 30, 1953 RESPIRATORY PARALYSIS IN POLIOMYELITIS BRITISH 1217 .~~~~~~~~~~~~~~~~EIA ORA also referred to a hand inflator developed by Professor Crown, and service to the -Crown (feodale servitium) was R. R. Macintosh, of Oxford, which was useful as an emer- rewarded by the grant either of land or of honours without gency measure. Dr. T. D. CULBERT thought that the land. These two classes of recipients of royal favours to- analysis of blood gases was often a help in managing gether formed the " Sergeantry " of the country-presum- patients being treated by artificial respiration. Dr. T. ably in contradistinction to either the aristocracy or the ANDERSON, who had visited Copenhagen, stressed the value peasantry. of team work in dealing with these cases, but the team The first recorded Sergeant-Surgeon was a certain William must have a leader. An adequately trained nursing staff Hobbes (1461), of whom little is known except that his was also important. Dr. E. C. BENN urged that a modified salary was "40 marks (£26 13s. 4d.) with wine, wax, and tank respirator should be designed to allow patients to be requisites for cure." Apparently at first there was only one nursed prone so as to ensure adequate postural drainage. Sergeant-Surgeon (as to-day), but Queen Elizabeth I was Dr. J. G. JOHNSTONE, on behalf of the Ministry, said that the first to appoint two, and later even more, " extra- specifications would shortly be circulated for the modifica- ordinary" Sergeant-Surgeons-this term having the old tion of the Both respirator, but these modifications would meaning of " supernumerary." It is still used in the medical not facilitate the use of postural drainage. Royal Household of to-day-usually in the sense of "retired." The Artificial Student There seems little doubt that in the early days the posi- At the conclusion of the meeting Dr. R. A. BEAVER tion carried military responsibility, the official duty of the demonstrated a machine which he had developed to provide Sergeant-Surgeon being to accompany his King on to the automatic compression and which could be used in con- field of battle, there to cater for the monarch's immediate junction with bag ventilation (the "artificial student "). medical needs. The last Sergeant-Surgeon on record as ful- Such a machine could be produced for £16, but at the filling this duty was John Ranby, who was with George II moment it was impossible to purchase the electric motors, at Dettingen in 1743. The status of the Sergeant-Surgeon as there was a delay of three months in delivery from the is well exemplified even in the days of the " United Com- manufacturers. He hoped shortly to publish details of his pany of Barbers and Surgeons" (1540-1745), when regula- machine. tions laid down that he should " sit next to the Past Master on the Bench when the Master do sit" and that as soon as possible he should be made master. After the surgeons' separation from the barbers (1745) the " Surgeons' Com- DOCTORS AT COURT pany," which continued until 1796, has records to show that THE MEDICAL HOUSEHOLD the Sergeant-Surgeon on his appointment must be admitted to the Council and Court of Examiners as soon as a vacancy The appointment of Court physicians and surgeons is in occurs and must be regarded as Master of the Company. the gift of the Lord Chamberlain, the chief officer of the The early Charters of the Royal College of Surgeons royal household. Those appointed are under his superin- (1820, 1822, and again in 1843) made the admission of the tendence in the same way as the dean of the chapels royal, Sergeant-Surgeon to the Court of Examiners compulsory, the groom of the robes, the poet laureate, the master of the but he had no preferential rights in respect of admission Queen's musick, the surveyor of the Queen's pictures, and to the Council. In 1852 these rights fell into abeyance. the bargemaster and keeper of the swans. Over the intervening years the Sergeant-Surgeon has come The present medical household consists of thirty-six to be regarded as the senior of the Royal Surgeons-his appointments. It includes three physicians; one physician- duties being in the main consultative. The present holder paediatrician; three extra-physicians; one sergeant-surgeon; of this office is two surgeons; three extra-surgeons a surgeon-oculist; an Sir Arthur Porritt. extra-manipulative surgeon; an extra-orthopaedic surgeon; The Royal Touch an aurist; a surgeon-dentist; an extra-surgeon-apothecary; James I surrounded himself with doctors, among them an extra-physician to the household; a surgeon-oculist to Sir Theodore de Mayerne, a Swiss; Sir William Paddy, who the household, together with an extra-surgeon-oculist; an was appointed by the King on his accession; and the ser- apothecary to the household; a surgeon-apothecary and an geant-surgeon, William Clowes, junior (whose father had extra-surgeon-apothecary to the household at Windsor, and been surgeon to Queen Elizabeth). Clowes was deputed a surgeon-apothecary to the household at Sandringham, specially to examine all persons brought in to be cured by and finally a coroner to the household. To this impressive the royal touch. In the pages of Pepys we have many of list must be added the medical department of the royal the King's doctors-Thomas Waldron, physician in ordinary household in Scotland, consisting of three physicians, two to Charles II; James Pierce, surgeon to the Duke of York. surgeons, one surgeon-oculist, a surgeon-dentist. and surgeon- And there was Dr. Frazer, with whom and with the rest of apothecaries to the households at Balmoral and Holyrood. the doctors much fault was found over the death of the The terms " ordinary " and " extraordinary " have re- Princess Royal in 1660. centlv been abolished. Francis Watson in his recent bio- We have the doctors in attendance at the deathbed of graphy Daivson of Penn states that the appointments which Anne-Sir Richard Blackmore, who had been physician are made to the " household " are nowadays full-time to William III; John Shadwell, who was also to be physician salaried posts, paid from the Civil List, and carry the re- to the first and second Georges, Richard Mead, who en- sponsibility of treating the entire staff at a royal residence. hanced his reputation in the succeeding dynasty by The other appointments are either honorary or, in one or " recovering the Princess of Wales, when the other physi- two cases, carry a small retaining fee. When the sovereign cians had certainly killed her," and John Arbuthnot, said to personally requires medical attention, any fee which may be have been Anne's most favoured physician, and not for- paid is from the Privy Purse. getting one who did not attend-namely, John Radcliffe, famous for his neglect of the summons. William III, inci- The Sergeant-Surgeon dentally, if Macaulay is to be trusted, addressed to his The attachment of certain medical men notable for their medical household on his deathbed these noble words: learning and skill (or sometimes perhaps principally for " Gentlemen, I know that you have done all that skill and their courtliness) to the service of the sovereign and the learning could do for me; but the case is beyond your art, court dates back to the earliest reigns. The sergeant- and I submit." surgeon goes back to the fifteenth century. The " sergeant" At the beginning of the nineteenth century there were part of this rather odd-sounding title seems to date back to in the King's service three physicians extraordinary, two feudal times and to derive from the Latin " serviens." In sergeant-surgeons, three surgeons extra to the person, one those days all dignities, honours, and public offices-to say surgeon to the household, and two surgeons extra to the nothing of the tenure of land-were derived from the household. A. dentist had by then taken the place of an 1218 MAY 30, 1953 THE MEDICAL HOUSEHOLD BOIuTsH earlier "operator for the teeth," and there was also an was Dr. J. A. Ryle; there was by then only one sergeant- " operator for the hands and feet." A few years later the surgeon, Wilfred Trotter, and there were two honorary number of physicians extraordinary was increased to five, surgeons, Sir Thomas Dunhill and Sir Hugh Rigby, and a one of whom was William Heberden, physician to both the surgeon to the household, Sir James Walton. In 1937 Lord King's and the Queen's household. There was a surgeon Horder and Sir John Weir joined the company of the to the household, an oculist, and an apothecary. And at physicians and Sir Farquhar Buzzard became an extra this time there was a new appointment in the medical list- physician. that of barber. At the death of George VI, in 1952, the physicians were Doctor's Orders Sir John Weir, Sir Horace Evans, and Sir Daniel Thomas Davies, with Lord Horder and Sir Henry Tidy as extra- In the reign of William IV the list of physicians in ordi- ordinary physicians. Sir Thomas Dunhill was sergeant- nary was headed year by year by the President of the Royal surgeon, and there were three surgeons and an extra sur- College of Physicians, but apparently this usage did not geon, and also a manipulative surgeon (Sir Morton Smart). survive the reign. As befitting a sailor king, William had a The total number of the medical household was twenty-four naval surgeon attached to his household. Although the in England and eight in Scotland. The number has re- fame of Brighton is associated chiefly with his predecessor, mained remarkably constant over fifty or more years.
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