SOME OF HIS CONTEMPORARIES, AND THEIR AMERICAN PUPILS By FRANCIS R. PACKARD, M.D. PHILADELPHIA

N THE seventeenth century the of the men on whose foundations the superiority of French surgery others built. They are of importance over that of other nations was in the early history of surgery in this quite generally, even if grudg- country because of their American pu- ingly, conceded. In his “Siècle de Louispils, men like Thomas Cadwalader, Ixiv,” wrote: James Lloyd and John Jones, who were Let us not pass over in silence the most the pioneers in the development of useful of all arts, that in which the French American surgery, and due to whose surpass all nations in the world—I mean example and advice young American surgery, of which the progress was so students went over in ever-increasing rapid, and so celebrated in this age, that numbers to avail themselves of the ad- people came to Paris from the extremities vantages of study in London. of Europe, for all those cures and opera- The predominating figure in English tions which required more than usual surgery during the first half of the dexterity; not solely were there excellent eighteenth century was William Chesel- surgeons in but it was even in this den (1688-1752). He began the study country alone, that the instruments neces- of medicine at an early age, for in 1703, sary to this science were perfectly manu- when but fifteen years old he became factured. This country furnished all its neighbors with them; and I learn, from a pupil of William Cowper, the famous the celebrated Cheselden, that he, for the anatomist who described Cowper’s first time, in 1715, caused to be manufac- glands. Later he became apprenticed to tured [in England] the instruments of his James Feme, at St. Thomas’s Hospital. art. Feme was especially licensed by the But with the early years of the eight- hospital authorities to cut for stone, eenth century Clio Medica, “the Medi- and it was probably his association with cal Muse” of Sir William Osler crossed Feme that led to Cheselden’s subse- the Channel, and for a century the lead- quent interest in the operation of lithot- ership in surgery was in the hands of omy. Cheselden began giving private the English and Scotch, and London courses in anatomy in 1710, and in was the center of the best surgical 1713 published his “Anatomy of the teaching and practice in the world. Humane Body,” a very popular book We are all familiar with the great which went through many editions. In London surgeons of the latter half of his dedication of the book to Sir Rich- the eighteenth century. , ard Mead, Cheselden expresses his grat- Abernethy and others are well-known itude to Mead for his help and encour- figures, but with the exception of agement in writing it. Cheselden and Pott we know much less In 1718 Cheselden was elected assist- ant surgeon to St. Thomas’s Hospital, the Transactions he described the and in the following year full surgeon, operation of iridectomy, or forming an a position he held until 1738. artificial pupil by making a slit in the In 1723 Cheselden published a iris. “Treatise on the High Operation for Cheselden was appointed surgeon to Stone,” in which he describes his Queen Caroline in 1727, but not long method of performing suprapubic after lost his favor at Court, because lithotomy. This occasioned a violent at- he had requested that he should be al- tack on Cheselden by Dr. John Doug- lowed to perforate the ear drum of a las, a Scotch surgeon practicing in deaf criminal who had been sentenced London, where he was surgeon-lithoto- to be hanged, in order to study the ef- mist to the Westminster Hospital. fect of the operation on the hearing. Douglas had just published a book, The convict was to be pardoned if he “Lithotomia Douglassiana, a New consented to the operation. Cheselden Method of Cutting for Stone,” in which says the man was taken ill and the he also described a method of perform- operation had to be deferred “during ing lithotomy by the suprapubic route. which time there was so great a public In a pamphlet entitled “Lithotomia clamor raised against it, that it was aft- Castratus,” which he published anony- erwards thought fit to forbid it.” When mously, Douglas accused Cheselden of the Queen suffered her last illness, a plagiary, notwithstanding the fact that strangulated umbilical hernia, a few Cheselden in his book had spoken in years later Cheselden was not called in high terms of Douglas’ book and had attendance. fully acknowledged his indebtedness to In 1723 Cheselden published his su- Pierre Franco and others. Shortly after- perb “Osteographia, or the Anatomy of wards Cheselden abandoned the high the Bones,” a beautifully illustrated or suprapubic operation in favor of his folio. In this excellent work Cheselden famous lateral operation through the not only gives very full descriptions perineum. This operation was based with accurate figures of the bones of on that devised by Rau, the Dutch the human body, but also many illus- lithotomist, who had studied the meth- trations of the bones of various animals, ods employed by Frère Jacques, the and it thus constitutes one of the first famous itinerant lithotomist, and im- well-illustrated books on comparative proved on them considerably. Chesel- anatomy. There is much humor as well den in turn devised a better operation as taste shown in the arrangement of than that of Rau. He is said to have the illustrations. Thus the skeleton of frequently employed less than a minute the cat is shown in an attitude of alarm, in removing a stone from the bladder. with raised back and tail, facing the In 1728 Cheselden published a paper skeleton of a dog. A heron’s skeleton is in the Philosophical Transactions of depicted with that of a fish in its bill, the Royal Society which created a great and the skeleton of a crocodile is wind- sensation. Cheselden had operated on ing its way with a pyramid in the back- a boy of thirteen for congenital cata- ground. The frontispiece represents ract, and in this paper he wrote a vivid Galen gazing at the skeleton of a bandit account of the boy’s experiences and who had been killed by some wayfarers sensations when he was able to see for he had attempted to rob. His body, left the first time. In the same volume of by the wayside, was soon stripped of its Ill ust rati ons from Ches eld en ’s “OsTEOGRAPHIA, OR THE ANATOMY OF THE BONES” fleshly integuments, and his skeleton the most noted and the most deserving in remained for Galen’s contemplation. the whole profession of chirurgery, and The animosity of Dr. John Douglas was has saved the lives of thousands by his again aroused by this publication and manner of cutting for stone. he gave vent to his spleen in a pam- Pope has commemorated his name in a phlet entitled “Animadversions on a couple of lines: late Pompous Book entituled ‘Osteogra- I’ll do what Mead and Cheselden advise, phia, or the Anatomy of the Bones,’ by To keep these limbs and to preserve these William Cheselden.” eyes. When St. George’s Hospital was founded in 1733-34 Cheselden was Jonathan Richardson, a well-known elected one of the surgeons and a few artist, wrote the following poetical ef- years later became consulting surgeon. fusion to Pope, after he had recovered In 1737 he was elected surgeon to Chel- from an illness: sea Hospital, and in the following year . . . Cheselden with candid wile, he resigned from St. Thomas’s. John Detains his guest; the ready Lares smile. Hunter was one of Cheselden’s pupils Good Chiron, so within his welcome bower, Received of verse the mild and sacred power, at Chelsea Hospital in 1749 and worked With anxious skill supplied the best relief, under him until Cheselden was inca- And healed with balm and soft discourse pacitated by an apoplectic stroke in his grief. J751- In 1732 a boy of twelve, named Cheselden was one of the two last Richard Yeo, wrote a poem to Chesel- wardens of the United Company of den entitled “The Grateful Patient,” Barbers and Surgeons, and it was proba- which Sir Benjamin Richardson quotes bly chiefly his influence and that of from the Gentlemans Magazine of John Ranby, the King’s sergeant sur- 1732. Cheselden had operated on Rich- geon, which brought about the separa- ard for a stone in the bladder. After tion of the Company into the two dis- describing the suffering he had under- tinct corporations of the Surgeons and gone prior to the operation, he con- Barbers in 1745. After having suffered tinues: a stroke of apoplexy in 1751, Cheselden retired to Bath, where he died April 10, The work was in a moment done, 1752. He was buried in the grounds of If possible without a groan, So swift thy hand I could not feel Chelsea Hospital. The progress of the cutting steel. Cheselden was a fine character, a man Aeneas could not less endure, of great culture and broad views. Sir Though Venus did attend the cure. B. W. Richardson quotes the following Not her soft touch, nor hand divine, interesting passage from a letter of Performed more tenderly than thine When by her help lapis own’d, Pope to Swift. Pope had been ill in The barbed arrow left the wound. 1735 in Cheselden’s home: For quicker e’er than sense or thought, As soon as I had received your last let- The latent ill to view was brought; ter, I received a most kind one from you And I beheld with ravish’d eyes expressing great pain for my late illness at The cause of all my agonies. And above all the race of men, Mr. Cheselden’s. I wondered a little at I bless my God for Cheselden. your querae who Cheselden was? It shows that the truest merit does not travel so far Cheselden attended Sir Isaac New- any way as on the wings of poetry; he is ton, and was a close friend of Sir , the founder of the British Mu- printed and sold by Benjamin Franklin seum. He had considerable artistic and in 1745. literary ability and is said to have drawn Dr. Cadwalader was elected consult- the plans for the old bridge over the ing physician to the Pennsylvania Hos- Thames at Putney, and for the old Sur- pital when that institution was founded geons Hall in Monkwell Street. He also in 1751 and he was closely associated assisted Van der Gucht in making the with Benjamin Franklin in founding drawings which illustrate his “Osteo- the Library Company of Philadelphia graphia.” and the American Philosophical So- The earliest American who studied ciety. He was famous for his pleasant under Cheselden was Thomas Bulfinch, manner, which on one occasion saved of Boston, who was one of Cheselden’s his life. A lieutenant in the army named pupils in the winter of 1718. Bulfinch Brulman one morning went out of his completed his studies in Paris in 1721. lodgings carrying his gun and with the The only record of his career after his avowed resolve of killing the first man return to Boston is contained in an he should meet. The Commons, now obituary notice written by his son-in- Penn Square, in which stands the City law, the Rev. Samuel Cooper, which is Hall in Philadelphia, then abounded merely a gushing tribute to his virtues with game. The first man he met was as a citizen and family man, only inci- Dr. Cadwalader, who, bowing politely dentally remarking that, “He was a said: “Good morning, Sir, what sport?” gentleman whose knowledge, fidelity Brulman stated afterwards that though and success in his business rendered the doctor was an entire stranger to him him an ornament to his profession.”1 he could not find it in his heart to kill Another of Cheselden’s pupils was him after such a pleasant greeting. His Thomas Cadwalader (1708-79), of resolution to kill someone, however, re- Philadelphia, who was one of the best mained unchanged, and meeting a Mr. known physicians of his day in that city. Scull shortly afterwards he shot and When nineteen or twenty years old he killed him, for which he was duly went abroad, and spent a year in Lon- hanged. don under Cheselden. He also spent James Lloyd (1728-1810), of Bos- some time in study at the University ton, was one of Cheselden’s most dis- of Rheims but did not get the degree tinguished pupils. When twenty-two of m.d . Returning to Philadelphia in years old Lloyd went abroad and passed 1730 or 1731 he made good use of his two years studying in London. While studies, giving demonstrations in anat- there he not only worked under Chesel- omy to the elder William Shippen, den and Sharp, but also attended Wil- then a young man, and other physicians liam Hunter’s lectures and worked in who had not had the opportunity to his dissection rooms, pursued the study benefit by study abroad. Dr. Cadwala- of midwifery under Smellie, and served der wrote what is generally considered as dresser to Joseph Warner at Guy’s the first medical monograph published Hospital. Nearly forty years later, in in America, “An Essay on the West In- 1789, Lloyd revisited London, where dia Dry Gripes, to which is added an he was warmly greeted by Warner and extraordinary Case in physics.” It was John Hunter. During Lloyd’s student 1 Quoted by Thacher, J. American Medi- years in London he saw much of John cal Biography, Boston, 1828. Hunter, who was working as his brother William’s assistant. When Lloyd re- first for four years in Paris, and after- turned to Boston in 1752 he soon ac- wards for two years in London. In the quired a large practice. He introduced latter city he studied especially under Cheselden’s method of amputation by Cheselden. He returned to America for making flaps instead of a circular inci- a long enough time to marry Miss Gib- sion, and is said to have been one of the bin, the daughter of his former precep- first surgeons in Boston to perform tor, and then went back to France to lithotomy. One of his most important devote two years more to work in the surgical achievements was to use liga- Paris hospitals. Gardiner settled in Bos- tures to stop arterial bleeding, and ton to practice about 1734, devoting thereby bring about the abandonment himself especially to obstetrics and sur- of the actual cauteries which had been gery, and to teaching students, illus- practically the only method used by sur- trating his instructions with many gical practitioners in New England to anatomical preparations which he had stop hemorrhage. Dr. Lloyd’s skill acquired in Paris. He established a brought him many pupils, among drugstore, or chemist’s shop, in Boston, whom should be named Joseph War- which was said to carry the largest stock ren, the doctor who became a major of pharmaceuticals in New England. general in the Colonial army and was Gardiner accumulated a fortune which killed at Bunker Hill, and Isaac Rand, he invested largely in a land company Sr., John Clarke and Theodore Parsons, which had acquired large tracts in what all of whom subsequently distinguished is now the state of Maine, where his themselves in their profession. Al- name is commemorated to the present though Dr. Lloyd was a Tory and re- day in the town of Gardiner. A few mained in Boston with the British years after his settling in Boston he was throughout the siege, he was held in the chief factor in organizing a medical such esteem by his fellow-citizens that society, the Medical Society of Boston, he remained in the city and was not before which on October 8, 1741, he molested in any way by the Americans performed a successful operation for after the British evacuated it. Dr. Lloyd stone in the bladder on an eight-year- was famed as an accoucheur as well as old boy, using the lateral method a surgeon and it was said that the originated by Cheselden. He also gave Americans were too gallant to interfere to the Society lectures on anatomy il- with one who was so necessary “for the lustrated with tables and preparations exigencies of the ladies.” In 1790 he re- he had brought back from abroad. Un- ceived the honorary degree of m.d . from fortunately for him Gardiner was an the Harvard Medical School. He died ardent Tory. When the British army full of years and honors at the age of evacuated Boston, he went with it to eighty-two. Halifax. John Morgan confiscated the Yet another of Cheselden’s pupils stock of his drugstore for the use of was Silvester Gardiner (1707-86), born the Continental Army. From Halifax in Narragansett, Rhode Island, but Gardiner went to England, where he who passed most of his active life in practiced at Poole in Dorsetshire, and Boston. He was apprenticed at the age received a small pension from the of fourteen years to an English physi- Crown. In 1788 Gardiner returned to cian named Gibbin, then practicing in America and died in the following year. Boston, and then went abroad to study, After considerable litigation his heirs succeeded in recovering much of his and a querulous, disagreeable old maid, landed property consisting of huge who kept his house in a turmoil by her tracts of timberland in Maine. continual quarrels with Mrs. Desmou- lins, Robert Levett and the other in- Ches eld en ’s Assi sta nt s mates. In a letter to Bennet Langton, (i7oo?-78) served his Johnson says: “Mr. Sharp is of opinion apprenticeship under Cheselden and that the tedious maturation of the cata- then assisted him in his teaching and ract is a vulgar error, and that it may in the preparation of his works on be removed as soon as it is formed.” anatomy, particularly his “Osteogra- Perhaps this may account for his failure phia,” on the title page of which is an in Miss Williams’ case. engraving representing the artist Van Sharp resigned from Guy’s Hospital der Gucht, drawing through a camera in 1757 but continued to practice un- obscura an anatomical figure suspended til 1765, when he traveled in Italy and on an easel, by which are standing on his return published his “Letters Sharp and the surgeon Belchier. Sharp from Italy” which excited much in- spent some time in France as a young terest, and provoked a reply from Ba- man studying French surgery and anat- retti, the Italian teacher living in omy, and while there he met Voltaire, London. Samuel Johnson said “there by whom he was much impressed. He was a great deal of matter” in Sharp’s was admitted to the United Company book. of the Barbers and Surgeons in 1732 Sir James Paget said: and the following year was elected sur- Sharp was a thoroughly informed sur- geon to Guy’s Hospital. Sharp gave geon, well read, observant, judicious, a courses of lectures on anatomy and sur- lover of simplicity, wisely doubtful. I gery to a “Society of Naval Surgeons,” think, too, he must have been an emi- and it is sometimes said that William nently safe man, who might be relied on Hunter took these lectures over when for knowing or doing whatever, in his he began giving his courses on anatomy, time, could be known or done for the in 1746, but Peachey has shown that good of his patients. In this view, I be- Hunter started his courses before Sharp lieve, he was as good a surgeon as Hunter; began giving his. In 1739 Sharp was but there is nothing in his books that can elected a Fellow of the Royal Society, be justly called pathology, nor any sign of and in the same year went to France. a really scientific method of study. They In 1750 he published a “Critical En- contain the practice, not the principles, of surgery. quiry into the Present State of Sur- gery,” which gives a valuable picture Sharp taught at least two subsequently of the status of surgery in France and distinguished Americans, James Lloyd England. One of Sharp’s patients was and Thomas Cadwalader, whom we Miss Anna Williams, daughter of a have just mentioned. Welsh physician upon whom he oper- A London surgeon whose name is ated unsuccessfully for cataract in 1752, seldom mentioned by any Americans in Samuel Johnson’s house in Gough who studied in London during the Square. She lived on the Lexicogra- eighteenth century, but with whom pher’s charity, forming one of his queer they must have come in contact, was household of dependents, until her John Belchier (1705-85) who was edu- death in 1783. She was totally blind, cated at Eton and then became appren- tice to Cheselden at St. Thomas’s Hos- lege of Physicians in 1721. In 1707 pital. In 1736 Belchier was appointed Douglas published his “Myographiae surgeon to Guy’s Hospital. Later in life Comparatae Specimen; or a Compara- he was a governor of both St. Thomas’s tive Description of all the Muscles in and Guy’s Hospitals. For the founder Man, with a special section on the Mus- of the latter institution he always ex- cles peculiar to Women,” a work on pressed unbounded esteem, saying “that anatomy which won the praise of no other man would have sacrificed Haller, and of which a Latin trans- 150,000 pounds for the benefit of his lation was published at Leyden in fellow creatures.” The Gentleman’s 1723. There were several subsequent Magazine published in 1743 the follow- English editions. Haller visited Doug- ing interesting story of an episode in las in London and bestowed high praise Belchier’s career: on his collection of anatomical speci- One Stephen Wright, who, as a patient, mens. He contributed many papers to came to Mr. Belchier, a surgeon, in Sun the Philosophical Transactions of the Court, being alone with him in the room, Royal Society, several of which are nota- clapt a pistol to his breast, demanding his ble. In 17162 Douglas published two money. Mr. Belchier offered him two papers in which, according to Dr. Nor- guineas, which he refused; but, accepting man Moore’s account of his life in the six guineas and a gold watch, as he was “Dictionary of National Biography” he putting them in his pocket Mr. Belchier anticipated two subsequent discoveries took the opportunity to seize upon him, of importance. In one paper on glands and after a struggle, secured him. in the spleen he described amyloid de- Belchier was not only a man of cour- generation of the malpighian bodies, age but also well cultured. He con- without, however, understanding its tributed a number of papers to the pathological significance which re- Royal Society, of which he was elected mained for Virchow to clear up. In the a member in 1732 and later to the other paper, reporting a case of hyper- Council. He figures with Samuel Sharp trophy of the heart, Douglas describes in the engraving on the title page of a murmur which he heard over the Cheselden’s “Osteographia.” aortic valves, and as Moore says: Although we do not know the names “needed but one more step forward to of any Americans who studied under have anticipated the discovery of aus- either James or John Douglas yet they cultation by Laennec.” In 1715 he pub- were so prominent in professional cir- lished a bibliography of anatomy from cles in London that they should be no- Hippocrates to Harvey, written in ticed. They were natives of Scotland Latin and manifesting the most pro- and their characters were in strong con- found erudition. In 1726 he published trast to one another. a “History of the Lateral Operation James Douglas (1665-1742), after for Stone,” the second edition of which getting his m.d . at the University of appeared in 1731 with an appendix Rheims, settled in London about 1700. containing a description of Cheselden’s He soon acquired a large midwifery method of performing the operation. practice and won distinction as an Cheselden in the preface to his “Anat- anatomist. He was elected a fellow of omy of the Human Body” had spoken the Royal Society in 1706 and became highly of Douglas’ anatomical skill. an honorary fellow of the Royal Col- 2 Phil. Tr. Roy. Soc., vol. 29, 1716. The friendly relations between Chesel- death in 1742. Hunter was engaged to den and James Douglas are worthy of be married to Douglas’ daughter but note because of the bitter animosity she died before they were married. with which Douglas’ brother, John, at- John Douglas ( -1744) has al- tacked Cheselden. In 1730 James Doug- ready been mentioned in his relation las published “A Description of the to Cheselden. He was surgeon-lithoto- Peritoneum, and of the Membrana Cel- mist to the Westminster Hospital, and lularis, which is on its outside,” in a fellow of the Royal Society. Douglas which he described the fold of the peri- gave private courses on surgery and toneum which was subsequently known anatomy. In 1720 he published “Lith- as Douglas’ pouch. Douglas also was a otomia Douglassiana, or Account of a skilled botanist and a great bibliophile. New Method of making the High Op- He had a remarkable collection of edi- eration in order to extract the Stone tions of Horace of which he published out of the Bladder, invented and suc- a catalogue in 1739. Pope commem- cessfully performed by J. D.” When orates him in the “Dunciad”: Cheselden published his “Treatise on To prove me, Goddess! clear of all design the High Operation for the Stone” in Bid me with Pollio sup, as well as dine: 1723, Douglas attacked him bitterly as There all the learn’d shall at the labour a plagiarist in a pamphlet entitled stand “Lithotomus Castratus,” and he again And Douglas lend his soft obstetric hand. vented his spleen against Cheselden In 1736 a great sensation was occa- after the latter had published his mag- sioned by a pamphlet entitled “A Short nificent “Osteographia,” in a pamphlet Narrative of an Extraordinary Deliv- “Animadversions on a late Pompous ery of Rabbets, performed by Mr. John Book entituled ‘Osteographia, or the Howard, Surgeon at Guilford,” and Anatomy of the Bones,’ by William published by W. St. André, Surgeon Cheselden, Esq.” and Anatomist to His Majesty. A woman named Mary Tost claimed to St . Bart hol omew ’s Hos pita l ; have given birth to a great number of Edwa rd Nou rse ; Perci va l Pott rabbits, and St. André stated that he Edward Nourse (1701-61) was the had helped Mr. Howard deliver them. son of a surgeon of Oxford, but served King George 1 and his Queen Caroline his apprenticeship under John Dobyns, were so much interested by this remark- one of the assistant surgeons to St. Bar- able report of the King’s anatomist that tholomew’s Hospital. When Nourse they sent Sir Richard Manningham, the got his diploma from the Barber-Sur- celebrated man midwife, to investigate geons Company in 1725, he instituted the case. Manningham took Dr. James a new procedure in the examination. It Douglas along with him and they had had, hitherto, always been customary but little trouble in exposing the fraud for the candidates to entertain the and obtaining Mary Tost’s confession. Court of Examiners at supper, but When William Hunter came to Lon- Nourse instead gave each examiner, of don he was a house pupil of William whom there were more than twelve, Smellie for some months but in the half a guinea to buy two pairs of gloves, summer of 1741 he left Smellie and be- and the innovation proved so satisfac- came the house pupil of James Doug- tory that it prevailed henceforth. las, with whom he lived until Douglas’ Nourse was elected assistant surgeon to

St. Bartholomew’s Hospital in 1731, teries heated and ready for the sur- and full surgeon in 1745. He was the geon’s use when he should enter the first surgeon at St. Bartholomew’s Hos- ward. Pott ceased using the cauteries pital to give regular courses in anatomy and also abolished the custom of apply- and surgery, and his only contribution ing escharotic dressings to wounds. to surgical literature was a syllabus of In 1756 Pott was thrown from his his lectures which was published in horse and suffered a compound frac- 1729. Nourse was elected a fellow of the ture of the leg. His son-in-law tells the Royal Society in 1728. His most distin- story of what occurred, which offers a guished pupil was his apprentice Perci- strong contrast to what happens under val Pott. such circumstances today: Percival Pott (1714-88) was the son Conscious of the dangers attendant 011 of a London scrivener, who died in fractures of this nature, and thoroughly very impoverished circumstances when aware how much they may be increased Pott was but three years old. His by rough treatment or improper position, mother was assisted in giving him his he would not suffer himself to be moved education by Dr. Wilcox, the Bishop until he had made the necessary disposi- of Rochester. Tucked away among tions. He sent to Westminster, then the Pott’s effects after his death there was nearest place, for two chairmen to bring found a box containing less than five their poles, and patiently lay on the cold pounds which was the total amount he pavement, it being the middle of January, received from his father’s estate. At the till they arrived. In this situation he pur- age of fifteen he was apprenticed to Ed- chased a door, to which he made them ward Nourse, the well-known surgeon nail their poles. When all was ready he to St. Bartholomew’s Hospital. Nourse caused himself to be laid on it, and was carried through Southwark, over London was one of the few London surgeons of Bridge, to Watling Street, near St. Paul’s, that time who gave private courses in where he had lived for some time. anatomy, and Pott laid the foundation of his profound anatomical knowledge The surgeons who first saw him in preparing the specimens for Nourse’s thought his leg should be amputated at lectures. In 1736 he was admitted a once and had prepared their instru- member of the Barber-Surgeons Com- ments when Mr. Nourse arrived on the pany, and when the Company was di- scene. Nourse decided that amputation vided in 1745 he became one of the was not necessary and the leg was saved. most active members of the newly Pott’s description of his injury has be- formed Company of Surgeons. In 1753 come classic and fractures of the lower he and John Hunter were appointed end of the fibula have borne the name the Company’s first lecturers or mas- “Pott’s fracture” ever since. ters of anatomy, and in 1765 he was During his time of long and tedious elected master or governor of the Com- convalescence Pott wrote his first book, pany. a “Treatise on Ruptures,” 1756. He In 1744 Pott was appointed assistant was then forty-one years old. surgeon to St. Bartholomew’s and in Pott gave private courses on anat- 1749 he became full surgeon. Pott did omy and surgery for some years, and in much to improve the status of surgery 1765 when he became senior surgeon in the Hospital. Before his time it had to St. Bartholomew’s Hospital he began been customary to have the actual cau- giving lectures to students of the Hos- pital which became the most popular best known American surgeon before and best attended courses in London. Physick. In 1787 he resigned from the Hospital John Jones (1729-91) came of a fam- after having, as he said, “served it man ily which had been among the early set- and boy for fifty years.” Pott contrib- tlers of the so-called Welsh Tract near uted much to surgical literature. In Philadelphia. His father, however, 1757 he published a paper on congeni- moved to Jamaica, Long Island, and in tal hernia which got him into a con- that town Jones was born. He began troversy with William Hunter, who the study of medicine when eighteen claimed that Pott had visited his dis- years old under Dr. Thomas Cadwal- secting rooms and studied his speci- ader, of Philadelphia, whose family had mens, and afterwards published, as his also come from Wales. On the termina- own, observations derived from Hunt- tion of his apprenticeship Jones went er’s work. abroad. He studied in London under In 1768 Pott published his classic William Hunter, McKenzie, the ob- “Observations on the Nature and Con- stetrician, and especially devoted him- sequences of those Injuries to which self to surgery with Percival Pott, at St. the Head is Liable from External Vio- Bartholomew’s Hospital. In 1751 Jones lence,” and with it “Some few Remarks crossed the Channel, and went to the upon Fractures and Dislocations,” University of Rheims, from which he which went through many editions and obtained the degree of m.d .; he then was highly esteemed for many years. In passed many months in Paris studying 1779 appeared Pott’s famous treatise anatomy and surgery with Petit, Le Cat “Remarks on that kind of Palsy of the and Le Dran. Later he went to Leyden Lower Limbs which is frequently and Edinburgh for further study be- found to accompany a Curvature of fore returning to America. Of all his the Spine,” in which he described with teachers Jones always expressed the great accuracy the condition of caries greatest esteem for Pott, and lost no op- of the vertebrae which has ever since portunity of expressing his sense of ob- gone by the name of “Pott’s disease.” ligation to him. Upon his return he After Pott’s death his son-in-law, Sir began practicing in New York City, James Earle, published his “Collected where he met with great success. He Works,” prefixed by a brief sketch of particularly distinguished himself by his life. performing the first lithotomy ever One of Pott’s most distinguished pa- done in that city, and its successful out- tients was Samuel Johnson, whom he come brought him many other patients treated in consultation with Cruik- suffering from stone in the bladder. Dr. shank for a sarcocele. Jones served as a surgeon in the Pro- Pott was a man of high character and vincial troops in the campaign of 1758 great generosity. It is said that at one during the French-Indian War, seeing time he had three poverty-stricken sur- active service around Lake George. Re- geons living in his house while he was turning to New York he resumed prac- trying to get them jobs. He stood at the ticing. When the Medical School of top of his profession in London. John King’s College was established in 1768 Hunter attended his lectures at St. Bar- Dr. Jones was elected to the chair of tholomew’s. Pott’s most distinguished surgery. A few years later he went over American pupil was John Jones, the to London, for the curious reason that the atmosphere of London relieved the known as Villa Nova, about twelve severe asthma from which he suffered. miles from Philadelphia, to visit his In London he resumed his studies friend, Charles Thomson, who had under William Hunter and Percival been secretary of the Continental Con- Pott. The latter was particularly kind gress. He became much overheated and to Jones, giving him a copy of his lec- fatigued. A few days later he became tures, and recommending him to peo- very ill and died of an acute fever. ple who wrote for his (Pott’s) advice The men we have considered were from the Colonies. In 1774 Jones re- the leading teachers and practitioners turned to America, and in the follow- of surgery in London from the begin- ing year, 1775, published the first ning of the eighteenth century until American textbook on surgery, “Plain, they were succeeded by John Hunter, Concise and Practical Remarks on the Abernethy, and others, who had been Treatment of Wounds and Fractures,” their pupils. There were, of course, which he dedicated to his old preceptor, many other surgeons practicing in Lon- Dr. Thomas Cadwalader. This was the don during this period, some of whom standard textbook for the surgeons in distinguished themselves in one way or the American Army throughout the another, but none of whom were on a Revolutionary War. par with those we have mentioned. Jones served for a short time in the Some were men who might have been Medical Department of the Continen- good teachers but were spoiled by ac- tal Army, but had to retire because of quiring large practices too early. Of ill-health. After the British evacuated these William Bromfield (1712-92) Philadelphia in 1778 Jones went there and Caesar Hawkins (1711-86) were and found his asthma so much bene- notable examples. Bromfield, when he fited by the climate that he moved there was but twenty-nine years old, was giv- to live in 1780. In the same year he was ing private courses on anatomy and sur- elected physician to the Pennsylvania gery to large classes of pupils. He and Hospital. When the College of Physi- Martin Madan originated and suc- cians of Philadelphia was founded in ceeded in establishing the Lock Hospi- 1787, Jones was elected to the vice- tal for venereal diseases. But in 1761 he presidency. Dr. Jones was Benjamin was appointed a member of the suite Franklin’s physician and has left an in- which went to bring the Princess of teresting account of that philosopher’s Mecklenberg to England to marry deathbed. In 1790 he was summoned George 111. He was appointed surgeon in great haste to New York to see to the Queen, acquired a fashionable George Washington in consultation. practice and, though he published a The President had some kind of acute book, “Chirurgical Cases and Observa- illness, associated with spasmodic tions,” in two volumes in 1773, he breathing and great debility. Though never achieved the fame he might have the description of his illness is not very had. definite it seems as though it might Caesar Hawkins was another sur- have been somewhat similar to that of geon who was ruined as a leader in his which he died. When Washington profession by the acquirement of a moved to Philadelphia he chose Jones large practice at an early age. In 1737, as his physician. On a hot day in June, one year after he was admitted to the 1791, Dr. Jones rode out to what is now United Company of the Barber-Sur- geons, he was chosen as its demon- through several editions. Warner was strator of anatomy. Unfortunately in admitted to the United Company in that year he was also appointed surgeon 1745, and he was the first member of to the Prince of Wales. Later he was the Royal College of Surgeons in 1800, sergeant surgeon to George n and thus being a member successively of all George hi , and in 1778 he was made a the different organizations of the sur- baronet. Hawkins is said to have been geons of England. Warner was also a a very dexterous operator. He invented fellow of the Royal Society of London. a cutting gorget which was much used in performing lateral lithotomy, and Teach ing Condi tion s in London his annual income from bloodletting Having thus glanced somewhat hast- alone was estimated at one thousand ily at the personalities who presided pounds. Unfortunately he is chiefly re- over the teaching and practice of sur- membered now as the opponent, not to gery during the first three-quarters of say the persecutor, of John Hunter at the eighteenth century we are now in St. George’s Hospital. a position to study the conditions which Sir D’Arcy Power says that John prevailed in London when young Hunter’s attainment of a large private Americans were going there in ever-in- practice was greatly hindered by the creasing numbers to finish their medi- predominance of these men, and Joseph cal education. Warner (1717-1801), whom I have The teaching of what we now call purposely not considered in the same internal medicine in London in the bracket with Bromfield and Hawkins eighteenth century lagged far behind because his work was on a much higher that of anatomy, surgery and obstetrics. plane. For systematic or clinical instruction in Joseph Warner served his appren- medicine students went to Leyden to ticeship with Samuel Sharp, and then study under Boerhaave, or later to served as joint lecturer with him on Edinburgh, where Cullen began his lec- anatomy at Guy’s Hospital. He went as tures on medicine in the English lan- a volunteer surgeon with the Duke of guage in 1757, and some went to Vi- Cumberland’s army to Scotland in 1745 enna where van Swieten began his and as such was present at the battle of clinical courses in 1745. It is curious to Culloden. From 1745 to 1780 he was reflect that none of the many brilliant surgeon to Guy’s Hospital where James men who ornamented the practice of Lloyd, of Boston, served as his dresser. medicine—physick as it was called dur- Warner was the first surgeon to tie the ing the eighteenth century—in London common carotid artery. His chief con- in any way carried on as teachers the tribution to surgical literature was a great tradition of Sydenham. Their book entitled “Cases in Surgery,” pub- names, characters and achievements are lished in 1754, which went through familiar to us in the pages of “The several editions and was translated and Gold-headed Cane,”3 but though they published in French. He wrote two had large practices and were interested other books, “A Description of the in various aspects of science they did Human Eye and its adjacent parts, to- not teach. Radcliffe left money to gether with their Principal Diseases” endow the Radcliffe Observatory, Li- (1773) and “An Account of the Testi- 3 Macmichael, W. The Gold-headed Cane. cles” (1774), both of which went N. Y., Hoeber, 1915. brary and Infirmary, and the RadclifEe and methods for many years. Edward Travelling Fellowships; Richard Mead Nourse and his pupil, later colleague, was famous as a bibliophile and col- Percival Pott, ruled the roost at St. lector; Sir Hans Sloane was the first Bartholomew’s Hospital. After Caesar physician to be made a baronet, and his Hawkins succeeded Cheselden at St. collections formed the nucleus of the George’s Hospital teaching in that in- British Museum; Garth, Arbuthnot stitution was much neglected until and Blackmore wrote poetry. Some- John Hunter was elected to the staff in what later Heberden, Fothergill and 1768 when it at once became a promi- Lettsom distinguished themselves by nent feature in the work of the Hos- their writings on medical and other pital. subjects, but not one of these great Although the student could get ex- physicians and scholars seems to have cellent instruction in surgery in Lon- realized the necessity for providing fa- don, and also had good opportunities cilities for the study of medicine, or at- for the study of obstetrics under the tempting to organize medical teaching. auspices of Smellie, James Douglas and It is hard to realize that until to- William Hunter—all Scotchmen prac- wards the last quarter of the century ticing and teaching midwifery in Lon- there were no regularly organized don—his opportunities for the study of schools in the hospitals where medical anatomy before the advent of William students received their instruction. The Hunter were very limited. Most of the surgeons were allowed to bring their surgeons who taught surgery also gave private pupils to the various hospitals, courses on anatomy, but their methods of which they were on the staff, but the of teaching were to say the least some- hospitals themselves did not organize what crude. There was no legal way of schools until much later. A medical obtaining bodies for dissection beyond student wishing to study in London the acts of Parliament which had or- would enroll himself as a pupil and pay dained that a few bodies of executed a fee to the surgeon whose work he criminals should be assigned each year wished to see, and then, to use the ordi- to each of the following institutions, nary phrase, he was privileged to “walk the Universities of Oxford and Cam- the hospital,” to which that gentleman bridge, the College of Physicians, the was attached, that is to witness his pre- United Company of the Barber-Sur- ceptor’s operations and accompany him geons and the Royal Society of London. when he made his rounds in the wards It is undoubtedly true that anato- of the hospital which he served. Thus mists used to get extra bodies by grave Cheselden’s private pupils went to St. robbing and other illicit means. In Thomas’s Hospital where Cheselden view of the fact that in those good old was surgeon during his best years, or days there were over one hundred of- St. George’s Hospital, to which he be- fenses besides murder to which the came surgeon when it was founded in death penalty was attached, such as 1733, or to Chelsea Hospital where he rape, forgery, certain forms of theft and worked in the latter years of his life. others, it would seem as though there Cheselden’s pupils, Samuel Sharp and should have been an ample supply of John Belchier, were surgical colleagues bodies of executed felons. Such, how- on the staff of Guy’s Hospital, where ever, was not the case. Vast crowds used they carried on Cheselden’s tradition to flock to Tyburn or other places wherever a hanging was to be carried his advertisement to have been “Pro- out. Besides the low-class mob many fessor of Anatomy of the Academy of persons of fashion and high standing Sciences at Paris,” exhibited in Lon- attended executions as a form of recre- don some “Anatomies in Wax-work,” ation. James Boswell, the biographer of which were in following years used for Samuel Johnson, the famous statesman demonstration purposes by various sur- Charles James Fox and his friend geons. Peachey quotes the advertise- George Selwyn, seldom missed an op- ments of several courses which were ad- portunity to witness such spectacles. vertised to be given upon them. In 1733 But even then popular sentimentality an advertisement was published stating: prevailed for the victims to such an ex- tent that many times the mob would To be seen this day and for the future, seize the body and prevent the officers price 5 s. at Mr. Lamark’s, Surgeon, in from delivering it over to the surgeons Orange Street, Leicester fields, Mr. Cho- for dissection. In many instances rela- vet, the surgeon’s New figure of Anatomy, tives or friends of the executed crim- which represents a woman chained down inal managed by bribery or other upon a table, suppos’d opened alive; wherein the circulation of the blood is means to secure the body. Thus teach- made visible through glass veins and ar- ers of anatomy were obliged to resort teries; the circulation is also seen from to illicit means, chiefly through the the mother to the child, and from the agency of professional grave robbers, or child to the mother, with the Histolick “resurrectionists,” to procure bodies [sic] and Diastolick motion of the heart for dissection. and the action of the lungs. All which par- Though they might be able to pro- ticulars, with several others, will be shown cure sufficient bodies in these various and clearly explained by Mr. Chovet him- ways for their own dissection or to self. Note, a Gentlewoman qualified will make preparations, they could not pos- attend the ladies. sibly under the circumstances provide These figures were not only used to enough cadavers to supply the needs of demonstrate anatomy to students but the students in their dissecting rooms. were also shown to any of the curious Consequently anatomy was taught by who might wish to see them. books, charts, casts and preparations. That Chovet was a surgeon in good George C. Peachey in his delightful standing is shown by the fact that in “Memoir of William and John Hun- the following year he was chosen Dem- ter” has published an immense amount onstrator of Anatomy to the Barber- of invaluable information on this sub- Surgeons Company, and held the posi- ject. He has gathered from contempo- rary advertisements in the newspapers tion until his resignation two years and from published syllabuses the rec- later. After this he went to the West ords of all the various courses given in Indies, where he remained until 1774, anatomy in London prior to the open- when in consequence of an insurrec- ing of William Hunter’s school in 1746. tion of the slaves, Chovet fled with his Among the teachers of anatomy by the wife and daughter to Philadelphia. old methods there was one who has a There he gave courses in anatomy in special interest for us because he later rivalry with Dr. William Shippen, Jr., lived and taught in Philadelphia. Some- who had been giving his courses since time about 1719 a M. Desnoue, said in 1763. Shippen had been a pupil of Wil- liam Hunter and he used cadavers for under the Care of the Physicians & to be his demonstrations. Chovet, on the con- by some of them explained to the Stu- trary, advertised his as given “without dents or Pupils who may attend the Hos- even the aspect of a dead body, which pital. often disgusts those, who otherwise Though Shippen used to attend at the would have both curiosity and inclina- Hospital at stated times to show these tion to attend that useful study; It is pictures and casts it is doubtful if he presumed his method of instructing relied on them very much in his teach- Anatomy will prove agreeable and sat- ing as he was too thoroughly imbued isfactory.” Coste, the chief of the medi- with the Hunterian tradition not to cal service of Rochambeau’s army, prefer the cadaver. wrote of Chovet in 1784 that he was “a It would be difficult to overempha- man skilled in all things pertaining to size the importance of the opening of medicine, and especially in anatomy William Hunter’s anatomical school on and surgery,” and the Marquis de the study of anatomy and indirectly of Chastellux said that many of his wax preparations equalled those in Bologna. surgery, in England. We have seen how John Adams said his cabinet of prep- anatomy was taught previously. In 1741 arations was “more exquisite” than William Hunter had taken up his resi- those of Dr. Shippen at the Hospital. dence with Dr. James Douglas, one of Chovet’s preparations were bought the best practical anatomists in Lon- by the Pennsylvania Hospital after his don, whom Hunter served as assistant, death, which occurred in 1790, at the but within less than a year Douglas age of eighty-six. After some years they died. After some time Hunter went to were lent to the University of Penn- Paris to study the French methods of sylvania, where they were still to be teaching anatomy, which were infi- seen until 1884, when a fire took place nitely superior to the English because in the building in which they were the students actually dissected the parts housed, and they were all destroyed. on the cadaver. In October, 1746, The Pennsylvania Hospital still pos- Hunter opened his school, stating in sesses some relics of the pre-Hunterian his advertisement that, “Gentlemen teaching of anatomy. In 1762, when may have the opportunity of learning William Shippen, Jr., returned from the Art of Dissecting during the whole studying in London, Dr. John Fother- winter season in the same manner as at gill, of London, the great benefactor of Paris.” The school was a success from the Hospital, sent over to it in his care the start. Two years later, in 1748, a gift of anatomical pictures and casts, John Hunter came up to London and accompanied by a letter to the Mana- soon became qualified as his brother’s gers of the Hospital, stating: assistant. For eleven years, until John’s I need not tell thee that the knowledge health broke down and he went with of Anatomy is of exceeding great use to the army on the expedition to Belleisle, Practitioners in Physic & Surgery & that the two brothers taught huge classes, the means of procuring Subjects with you which included many young Ameri- are not easy, some pretty accurate ana- tomical Drawings about half as big as the cans in their ranks. Life have fallen into my hands & which I There is no doubt that the reason purpose to send to your Hospital to be why William Hunter could start a pri- vate anatomical school in 1746 with op- possible for anatomists to give private portunities for the student to actually courses with human dissections. dissect was largely because of the sep- The reason that the Hunters so far aration of the Barbers from the Sur- excelled all their predecessors as teach- geons which took place in the previous ers of anatomy and surgery was because year (1745). The United Company of their teaching was based on a profound the Barbers and Surgeons had a by-law knowledge of human and comparative which forbade any of the members of anatomy and pathology, and they the corporation to give courses in dis- taught not merely the art but the sci- section in their private rooms. The ob- ence of those subjects. Before their time ject of the by-law was probably to con- Cheselden and his contemporaries and centrate actual dissection as much as followers taught the art of anatomy and possible in the Barber-Surgeons’ Hall, surgery, the structure of the body and and was prompted by the scarcity of the art of operating, but their teaching cadavers. On one occasion Cheselden did not train their pupils in scientific was severely censured by the officers of observation and methods. When we the Barber-Surgeons Company because contrast the teaching and practice of he had given a course in dissection to surgery in London before the Hunters’ students in his private rooms. When time, with that which followed them, the Company was separated the by-law we are struck with wonder at the was abrogated so that from 1745 it was changes wrought by their influence.