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. It one of William's physicians extraordinary, two of his sur- has been lessened by the lapse of the Irish appointments, geons extraordinary, and his surgeon-dentist all carried the but increased again by the number of specialist appointments appellation " of Brighton." The " operator on the foot" which have been created. had by now become the surgeon-chiropodist. Another surgeon in the household of William was Robert Keate, who was also one of the three sergeant-surgeons in the early reign of Queen Victoria. Of Keate it is told that he was Nova et Vetera summoned to Queen Adelaide, who had pain in the knee. The King was present, and the Queen intimated to the surgeon that he should ask him to withdraw. " I'm hanged if I do," said William. "Then I'll be hanged if I stay," MEDICINE AND THE ABBEY said Keate. The King gave way. "You doctors can do Among the famous persons commemorated in Westminster anything," he said, " but if the Prime Minister or the Lord Abbey fourteen were members of the medical profession. Chancellor had presumed to order me out of the room it There are also memorials to an unqualified practitioner would be his successor I should interview to-morrow." and to a distinguished experimental physiologist. The In addition to Keate there were two other sergeant- remains of six of these men lie in the Abbey, the others surgeons in Queen Victoria's first medical list-Sir Astley being commemorated by memorial tablets and busts. Six Cooper, who had attended William IV and George IV, and were natives of Scotland. Two (Goldsmith and Livingstone) Sir Benjamin Brodie. The physicians in ordinary included are remembered for work outside the field of medicine. Sir James Clark (whose tenure of the office was long if not John Woodivard (1665-1728), the first medical man to be very glorious), Sir Henry Halford, and Dr. W. F. Chambers. buried in the Abbey, was professor of physic at Gresham Queen Victoria gave birth to her first child in 1840, and the College. He wrote extensively on geology and natural list for 1841 includes a first physician-accoucheur, Charles history. His incessant quarrels with Mead and Freind (see Locock, a second physician-accoucheur, Robert Ferguson, below) led on one occasion to a duel with the former be- and a surgeon-accoucheur, Richard Blackburn. Later in the neath the walls of the Royal College of Physicians in Queen's reign, in 1862, William Jenner became physician in Warwick Lane. ordinary, and in the following year the Prince of Wales set Hugh Chamberlen, the Younger (1664-1728), was the last up his medical household, of which Jenner was a member, member of the family famous for their " secret instrument," as was also James Paget, who had been appointed to the the obstetric forceps, and was responsible for its becoming household of Queen Victoria in 1858. At this time there public. He was three times censor of the Royal College were apothecaries to the households at Windsor and Osborne, of Physicians. and physicians and surgeons attached to Her Majesty in John Freind (1675-1728), physician and politician, was Scotland and in Ireland. In 1887, the year of the Queen's Queen Caroline's physician and a lifelong friend of Richard jubilee, Joseph Lister's name appears as surgeon extra- Mead. His History of Physick from the Time of Galen to ordinary. the Beginning of the Sixteenth Century (1725-7) marks him as the first English medical historian. His monument in- The Twentieth Century cludes a lengthy Latin epitaph on which Pope pronounced: The first medical household of Edward VII consisted of " One half of which will never be believed, the other never three physicians in ordinary-Sir W. H. Broadbent, Sir read." James Reid, and Sir Francis Laking-and five physicians Richard Mead (1673-1754), a native of Stepney, studied extraordinary. Sir Thomas Barlow was physician to the medicine at Padua and Oxford. He was physician to household. Lord Lister was sergeant-surgeon, and there George II, and enjoyed a large and fashionable practice. were two honorary sergeant-surgeons, one of whom was Rev. Stephen Hales (1677-1761), physiologist, botanist, Sir Frederick Treves, and three surgeons in ordinary. Other and inventor, was perpetual curate of Teddington, Middle- offices included that of an anaesthetist and a surgeon- sex. His physiological experiments included the first apothecary to the household at Sandringham. measurement of the blood pressure, for which he devised In the first year of the reign of George V the physicians the manometer. in ordinary remained as they had been ten years earlier Joshuia Ward (1685-1761) was a quack doctor and philan- except that Sir Richard Powell had taken the place of Sir thropist whose " drop and pill " made him famous. He is W. H. Broadbent. Bertrand Dawson was one of the three said to have invented " Friar's balsam." He founded a physicians extraordinary, his appointment having been made hospital near Buckingham Palace. In his will he expressed by Edward VII in 1907. Sir Thomas Barlow was still a wish to be buried in front of or near the altar of West- physician to the household, and Lord Lister sergeant- minster Abbey. His body lies in the south transept. surgeon with Sir Frederick Treves. Sir Anthony Bowlby Oliver Goldsmith (1728 or 1730-1774). After studying was surgeon to the household, and a new appointment was medicine at Edinburgh and Leyden without success, Gold- that of bacteriologist (Dr. Spitta). Among other offices smith obtained a dubious medical diploma at Louvain or was that of laryngologist (Sir Milsom Rees). At the end Padua. He practised for a short time in Southwark before of the reign the physicians in ordinary were Lord Dawson turning to literature. The Literary Club, of which he was of Penn and Sir Farquhar Buzzard, and the physicians one of the nine original members, erected his monument (by extraordinary Sir Humphry Rolleston, Sir Thomas Barlow, Nollekens) in the Poets' Corner, and Dr. Johnson wrote the and Sir Maurice Cassidy; the physician to the household epitaph.