WILLIAM CHESELDEN AND THE SEPARATION OF THE BARBERS FROM THE SURGEONS Thomas Vicary Lecture delivered at the Royal College of Surgeons of England on 30th October, 1952 by Sir , F.R.C.S. THE BARBERS AND the Surgeons have been friendly for more than four hundred years, for even at their separation, in 1745, there was no evidence of any animosity, and at no time since has there been anything but harmony between the two bodies. This is fortunate for anyone who wishes to talk about William Cheselden, for, while Vicary worthily typifies the union of the Barbers with the Surgeons, Cheselden was almost certainly the main influence in bringing about their separation. This year celebrates the bicentenary of the death of this famous man, the only truly eminent English surgeon in the first half of the eighteenth century, the last elected Warden of the Barber-Surgeons Company, and one of the first-appointed Wardens in the newly incorporated Company of Surgeons. On the 19th October, 1688, just a fortnight before William of Orange landed in this country, William Cheselden was born at Burrow on the Hill in Leicestershire, in a house situated in an outlying part of the parish of Somerby, about ten miles east and slightly to the north of Leicester City. He was the third child and second son of George Cheselden, a yeoman farmer and a descendant of an old Rutland and Leicestershire family. William was taught the elements of knowledge at the Queen Elizabeth Grammar School (now Wyggeston School) and no doubt received a sound elementary education there. The only incident of interest in his childhood was the sustaining of a fracture of the forearm which (he tells us) was treated by a bonesetter who bound it in a bandage stiffened by a mixture of white of eggs and wheat flour. Cheselden remembered this method of treatment and, later in life, used to treat children with congenital talipes by bandaging the limb in the correct position by means of such a bandage. It has been stated that as a youth he worked for a while with a Doctor Wilkes of Leicester, but I have been unable to find any confirmation of this. When he was fifteen years old he came to London and was apprenticed to a young surgeon named James Ferne, who had recently been put on the surgical staff of St. Thomas's Hospital, which at that time was situated just south of London Bridge. While a student he is said to have lived in the house of William Cowper, the celebrated anatomist, but where this was we do not know. The fact that the Bishop's list on which he was enrolled in 1712 states that he was admitted as from St. Dunstan's in the East makes it likely that he was living in that parish, which is near the Monument. I V. ZACHARY COPE

"I 7" --77 -, ", -. 1- ".,

William Cheselden. From the first Cheselden was a keen student of anatomy and he must have learned much from Cowper; it is possible also that he may have attended the anatomical lectures of Rolfe, who held classes in a house in Chancery Lane about this time. Rolfe left London in 1706 and William Cowper died in 1709 so that, when in 1710 Cheselden completed his apprenticeship and became a freeman of the Barber-Surgeons Com- pany, there was no one giving regular lectures on anatomy in London. The newly-fledged barber-surgeon saw his -opportunity and took it. He drew up a detailed syllabus of a course of lectures on anatomy. which he arranged to deliver three times a year. This syllabus, which extended to thirty-six pages, was printed and entered at Stationers Hall on the 8th October, 1711, when Cheselden was only twenty-three years old. The money obtained by giving these lectures must have helped to maintain him while he was waiting for patients to come. The next year he read a short paper before the Royal Society on some bones dug up from the old Roman site of Verulamium, and he was thereafter elected a Fellow 2 THOMAS VICARY LECTURE of that august Society. In this same year, 1712, he took as his first apprentice a student named Robert Hillier, who was bound to him for seven years in return for the sum of one hundred and fifty pounds. At the time Cheselden began his lectures there was no small and suitable manual of anatomy in English, so this enterprising youth wrote down the substance of his lectures, illustrated them by twenty-six plates, and in 1713 published them as a book. The moment was opportune and, though the lectures were written in a discursive style, they were interesting and lightened up with physiological discussions and accounts of surgical cases, so that the book caught the student's fancy and kept it for a hundred years. Thirteen English editions, two American editions and one German edition appeared in that hundred years, and Cheselden's anatomy must have been used by many if not most of the students who attended the classes of all the great anatomical teachers during that important period. Some of the illustrations were strikingly unusual yet remarkably instructive. Encouraged by the success of his lectures and hopeful of the prospects of his book Cheselden, in that same year, 1713, ventured to give hostages to fortune by marrying Deborah Knight, the niece of the unfortunate cashier of the South Sea Company. The young couple went to live in a house in Cheapside, next door to the Saddlers Hall, on the north side of that thoroughfare close to St. Vedast's Church; this house was only two hundred yards from Monkwell Street in which the Barber- Surgeons Hall was situated. The first year of his married life brought with it many disappointments. He had already made up his mind to be a surgeon and in 1714 he applied for a vacancy on the surgical staff at St. Thomas's, but was unsuccessful. The second disappointment was of great importance, both to Cheselden and the future of surgery. We know that Cheselden's lectures were popular and that they drew students away from the more dull official lectures delivered at the Barber-Surgeon's Hall. For purposes of demonstration and dissection, however, he needed subjects, and he took the liberty of procuring the bodies of felons from the place of execution. This he had done, unfortunately, without first obtaining permission from the authorities. For this omission he was called before the Court of the Company and censured, though he was forgiven on his promising not to repeat the offence. Though outwardly submissive Cheselden never forgot this censure, which was probably the initial motive which directed his thoughts towards the advisability of the separation of the Surgeons from the Barbers. At the time he neither wrote nor said anything publicly against the Company, but the sense of frustration lasted throughout his life until the separation took place. It was also in this fateful year that his wife was delivered of a female child, Deborah, who died in infancy. In the records of St. Vedast's there is no record of birth nor ofchristening but only of the burial of the little infant Deborah. Under the date 24th July, 1714, the churchwardens 3 V. ZACHARY COPE record the burial of the infant in the vault of St. Vedast's, and the accounts state that eight shillings and fourpence were paid for the expense of the funeral and the tolling of the " fifth" bell of the chime. Financially, the year 1714 showed some improvement, for in September William took his younger brother, Peter, as his apprentice for seven years for the sum of two hundred pounds. It is likely that his lectures were also proving remunerative for it was also in 1714 that Cheselden invested a thousand pounds in South Sea Stock which had just been offered to the public. The fact that his wife's uncle was cashier may have induced him to make this investment, but it is probable that he lost money, at a time when he could little afford to do so. In 1715 Cheselden again tried for a surgical post at St. Thomas's and again he was unsuccessful. The following year his wife bore another daughter. It is possible that the parents had been hoping for a son, as the child was christened Williamina or Wilhelmina. There was never any further addition to their family. In July, 1718, the increased surgical work at St. Thomas's made it necessary to appoint an assistant surgeon, and, from several applicants, Cheselden was chosen to fill the post. He was then aged 30. He soon proved his worth, for, when one of the senior surgeons fell ill and Cheselden deputised for him, he carried out his dpties so ably that, when his senior died, Cheselden was appointed one of the full surgeons without any competition. This was the turning point in his career for it gave him the opportunity to prove his surgical worth, and at the same time guaran- teed him at least a moderate income from the hospital honoraria and the fees from the pupils. With these new and better prospects, in 1720 he moyed from Cheapside, probably to the address in Red Lion Street, Bloomsbury, where we know he lived later. Here he was near Great Ormond Street where his friend Richard Mead lived, and quite close to Red Lion Square and Queen Square where his friends James Douglas and Jonathan Richardson respectively resided. During the 17 years that he remained on the active staff of St. Thomas's Cheselden became the best known surgeon in Great Britain, and probably in the world. He continued his popular lectures on anatomy for several years and gradually became known as a good general surgeon, a dis- tinguished ophthalmic surgeon and a superb lithotomist. As a lithotomist he has never been surpassed and probably never equalled for skill, speed and success, but he did not attain that perfection without a process of trial and error. He started with the supra-pubic operation. John Douglas in 1719 had revived this operation successfully, but Cheselden was the only other London surgeon who was at first prepared to try the method; he did so with such success, and his book on the subject was published so speedily (in 1723) that he drew away from John Douglas much of the credit and publicity that he had previously obtained. This converted John Douglas from a good friend to a bitter enemy. Cheselden soon found the supra-pubic operation unsatisfactory and reverted to the perineal method, adopting a slight modification of the 4 THOMAS VICARY LECTURE operation introduced by Frere Jacques, cutting rather to one side of, rather than immediately on to, the staff introduced into the distended bladder. Soon, however, he found it safer to be guided by the grooved staff or catheter and between 1727 and 1731 he perfected the technique of lateral lithotomy, making several small but important modifications which differentiated it from any previous technique. Cheselden himself wrote a very imperfect account of his own technique, but, fortunately, Dr. James Douglas, who frequently watched Cheselden operate and was able to obtain from him the full details of all the steps of the operation, in 1731 published a very full and clear account with a description of the instruments used. A laterally grooved catheter or sound was introduced into the bladder and firmly held, not by the surgeon, but by an assistant who directed the handle slightly towards the patient's right thigh but kept the curved other end well up against the pubic arch. An oblique incision was then made beginning from the median raphe just behind the scrotum and ending just behind the level of the tuber ischii, half an inch lateral to the anus. The middle of the incision was deep. The forefinger of the left hand was then immediately introduced into the wound and by it the rectum was pressed back out of harm's way throughout the rest of the operation. The knife was then plunged more deeply and, entering the lateral groove of the catheter just above the prostate, cut through the lateral part of that gland from the base to the apex. The gorget was then introduced, the catheter withdrawn and the forceps introduced to grasp the stone. The forceps were gripped by both hands, one hand grasping the ends of the handles and the other taking a grip of the middle, and extraction was done carefully and slowly. James Douglas, who was a very accurate observer, stated that Cheselden seldom took more than half a minute to perform this operation in uncom- plicated cases. The Frenchman Morand testified that he saw Cheselden remove a stone in 54 seconds. Cheselden only published the results of the operations performed on his hospital patients, for, said he, he only wished to claim results which were open to confirmation by others who had seen the operations performed. Of 213 patients whom he cut for stone at St. Thomas's Hospital, he lost less than 10 per cent. Of 105 patients under 10 years of age, only three died. These were deservedly claimed as remarkable results. Patients came to consult him from all parts; it is recorded that from Sweden came Baron Carlsen from whom in two minutes Cheselden removed two stones each as big as a large walnut, and three of a smaller size. On one occasion he travelled to Chester to operate on a patient. M. Morand came over from Paris to report on Cheselden's methods and as a result of his report Cheselden was made an honorary member of the French Academy of Sciences in 1729, and in 1732 he became the first foreign member of the French Royal Academy of Surgery which had just been formed in Paris. What probably pleased him still more was his appointment as surgeon to Queen Caroline, wife 5 V. ZACHARY COPE of King George II. This appointment may have been due to the recom- mendation of Dr. James Douglas, his great admirer, who was at that time physician to the Queen. Unfortunately he lost this appointment before a decade had passed; why he lost it we do not know for certain, but rumour had it that he lost favour because he had intended to operate upon the drum of the ear of a condemned criminal who was to be pardoned if he consented to have the operation performed. The proposed operation was intended to determine if hearing were diminished if the drum of the ear were incised ; public comment was made about the proposed operation and, though it was never performed, it appears to have made Cheselden unpopular for the time. The loss of the royal appointment brought it about that, when Queen Caroline was taken ill with a strangulated umbilical hernia (in 1737) Cheselden was not called in consultation. If he had been consulted it is possible that there might have been a different result to the illness for, prior to that date, Cheselden had published an interesting account of a successful operation for that condition. In 1724 Cheselden was appointed lithotomist to the recently opened Westminster Infirmary and, when St. George's Hospital was opened in 1733, he was also put on the staff there as lithotomist. In that same year, 1733, he published his great atlas of the skeleton which he had been care- fully preparing for several years. Osteographia is a fine work but its artistic is perhaps greater than its practical value. Cheselden had considerable natural artistic ability and this he cultivated by attending the Academy of Art founded by Vanderbank in St. Martin's Lane about 1720. He took great trouble and spent much time in making the illustrations and a volume of his original drawings was until recently to be seen in the library of the Royal Academy.* The first sketch is a delicate self-portrait, profile, of Cheselden himself. The frontispiece of Osteographia shows Cheselden drawing with the aid of a camera obscura while his pupils Sharp and Belchier stand by and assist him. Many of the illustrations in the book are bizarre and the letter-press is inadequate, but the production is beautiful and accurate. Only 500 copies were printed and only about half were sold, and the author lost a considerable amount of money over it-about a thousand pounds rumour had it. That Cheselden was experienced in the surgery of the eye will be known to everyone who has read Pope's Imitations of Horace: I'll do what Mead and Cheselden advise To keep these limbs and to preserve these eyes. In the history of ophthalmic surgery he is noted as the first ever to per- form an operation for making an artificial pupil. He frequently operated for cataract by the method of couching or displacement of the lens; it was not indeed until the year of his death that excision of the lens for cataract was recommended by Daviel. Considerable public interest was

* This volume of drawings has now been loaned to the Royal College of Surgeons by the authorities of the Royal Academy. 6 THOMAS VICARY LECTURE created by the publication by Cheselden of an account of the sensations of a young man who received his sight after being blind since birth; this account is still worth reading. Cheselden was not only artistic but he understood something about architecture as was shown by the remarkable part he took in the building of the old Fulham or Putney Bridge. In 1720 a Londoner could only cross the Thames on foot at London Bridge. Westminster and the other bridges did not exist. There was particular need for a bridge at Putney or Fulham because it was there that the traveller to the south-west had to cross the river to join the Portsmouth Road. In 1726, Parliament gave permission for the building of a bridge at that site. Commissioners were appointed and in 1728 were incor- porated. A public subscription failed to raise enough money, so the 30 commissioners agreed to subscribe £1,000 each, a sum which would be amply sufficient for the building of the bridge and for compensating the watermen and owners of the ferry. Cheselden was not one of the original commissioners but he was elected to fill a vacancy at the beginning of active operations on November 28, 1728. Sir Robert Walpole and Sir Charles Wager were among the commissioners. From the first Cheselden played an important part in the building of the bridge. He was one of five appointed to consider the various designs for the bridge sent in by a number of competitors. The design of Sir Jacob Ackworth was accepted. Cheselden then served on the committee which had to decide on the particular form and construction of the bridge, and on another appointed to look through the estimates and prepare the contract. Most important of all, he was a prominent member of the committee of nine which was entrusted with the responsible task of inspecting the actual work of construction. In this committee two formed a quorum and scrutiny of the minutes makes it clear that the chief work of inspection was done by Cheselden and by Mr. Ripley, who at that time held the responsible post of Controller of the Board of Works, and, incidentally, had been one of the unsuccessful candidates for the design of the bridge. Cheselden held his own well with this professional, and in one instance which had to do with the building of the brick approaches to the bridge, the commissioners supported Cheselden's view against that of Ripley, much to the latter's chagrin. Cheselden did not design Fulham Bridge but he must have been responsible for considerable modification of the plans put forward by Ackworth, for, on July 2, 1730, just before the bridge was opened, the following resolution was passed by the proprietors: " Resolved, as the bridge is built entirely according to a scheme and principles laid down by Mr. Cheselden, and as he has been very serviceable in directing the execution of the same, that the thanks of the proprietors be given to him for advantages which have been received from his advice and assistance, they being of opinion that no timber bridge can be built in a more substantial and commodious manner than is now erected." 7 V. ZACHARY COPE There can be no doubt that Cheselden must have had a good sense of line and proportion and knew something of building construction and materials. We cannot refrain from quoting a facetious remark made by Faulkner in his History ofFulham: " Mr. Cheselden, then one of the leading surgeons of his time, gained his experience.in architecture while practising at Chelsea Hospital, which enabled him to design a bridge standing on so many wooden legs." He might perhaps have added that he worked as well in wood as in stones. As everyone knows the bridge was a great success, proved a profitable investment, and lasted for nearly a hundred and fifty years. In September, 1736, Cheselden's daughter Wilhelmina married Dr. Charles Cotes, a clever young physician who was on the staff of West- minster Hospital and was also Member of Parliament for Tamworth. The young lady was not yet of age but her father gave his consent to the marriage and, we may conclude, thought highly of the young man, who at a later date was destined to play an important political part in the separation of the surgeons from the barbers. In 1737 Cheselden was in his fiftieth year; he was at the height of his fame, was working at three hospitals, possessed an international reputa- tion, drew students and pupils from the Continent and from America, was the friend of Pope and Stukeley, of and Richard Mead, had a comfortable income and was universally respected and liked. He chose that year to retire from all his hospital appointments and accept the less onerous and much less responsible post of surgeon to the Royal Hospital, Chelsea. It is of some significance that in the very year in which he chose a less strenuous life Cheselden began to take an increased interest in the Barber-Surgeons Company. In December 1738, nine months after his retirement from St. Thomas's, he was elected to the Court of Assis- tants, and on April 27, 1739, he took the oath and paid the admission money. In the same year he was elected to the Court of Examiners by a special arrangement whereby he did the work but let a certain Mr. Myddleton receive the fees and perquisites of the office. It would appear that Mr. Myddleton must have resigned in order to make way for Chesel- den. For several years Cheselden was a regular attendant at both the Court of Assistants and the Court of Examiners but, towards the end of 1742, he became very irregular in his attendance. In the year 1743-4, between one election day and the next he only attended four out of 11 meetings ofthe Court of Assistants, and only two out of 14 meetings of the Examiners. In August, 1744, however, in his absence, he was elected Fourth Master or Governor Renter Warden of the Company, and once again he began to attend more regularly, and he was present on that eventful day, the memorable December 20, 1744, when like a bolt from the blue " the Gentlemen on the Surgeons side made known their desire of being separated from the Gentlemen on the Barbers side, and produced a case intended to be offered to the Honourable House of Commons praying such separation." We are not told by whom the desire was made 8 THOMAS VICARY LECTURE known nor what had led up to it. Before considering this problem we will continue with the course of events. A joint committee of barbers and surgeons discussed the matter and thereafter the barbers held a special meeting and dissented from the surgeons' proposal. On January 31, 1744-5 the surgeons petitioned the House of Commons and a week later the barbers sent up a counter- petition. Both the petitions were referred to a special committee of the House consisting of 70 members. Counsel were permitted to be heard on behalf of both parties. It is noteworthy that among those on the special committee were William Pitt, afterwards Earl of Chatham, Sir Henry Fox, afterwards Lord Holland, Sir Hugh Smithson, afterwards Earl Percy, Alderman Gibbon, the father of the historian, Horace Walpole, and many other distinguished members. Yet the most interesting fact elicited by reading the account in the Journals of the House of Commons is that the name of young Doctor Cotes, the son-in-law of Cheselden, comes first on the list of members of the committee, and that it was he who was chosen as chairman, and it was by him that the report of the committee was made to the House on February 27, 1744-5. The surgeons claimed that their union with the barbers was incon- venient in many respects and in no degree conducive to the progress or improvement of the art of surgery. The barbers denied this and asserted that all the advantages of the union were for two hundred years on the side of the surgeons, who ought to submit now that the advantages were on the side of the barbers. They added an argument which may have had considerable weight against their own case: " that they are unable to pro- vide for their numerous poor without the assistance of the surgeons." The committee interviewed witnesses and examined many documents and came to the conclusion that the surgeons had made good the allega- tions of their petition. The report of the committee was read to the House by Dr. Cotes on February 27, 1744-5, and the House agreed with their conclusions and directed that Dr. Cotes, Mr. Carew, Mr. Knight and Mr. Bacon should prepare and bring in a Bill to implement them. This Bill was presented by Dr. Cotes on March 8, when it was read for the first time. The Bill became law on May 2, 1745. It concerns us to know what part Cheselden took in bringing about this separation. Admittedly it is difficult to procure direct evidence of his actions, yet a consideration of the known facts makes it almost certain that he was the prime mover in the whole business. I have already given my opinion that at the beginning of his surgical career he recognised the difficulty of reform of the Barber-Surgeons Company and had come to the conclusion that it would be impossible to advance surgical education until the two bodies were separated. This opinion is based upon the statement he made in 1749, four years after the separation: "And the rulers of the Barber-Surgeons Company at the same time contrived a bylaw to prevent the knowledge of anatomy from spreading; 9 V. ZACHARY COPE cunningly foreseeing that the younger surgeons by that knowledge would advance too fast upon them. They made it a penalty of ten pounds to dissect a body out of the hall without their leave, which was scarce to be obtained; and if anyone offended (as they call'd it) they were sure to be prosecuted. The improvements in anatomy since their restraints have been removed will sufficiently convince the world of the unfitness of them." Do you not agree that this statement made 35 years after the censure of 1714 shows that he had felt the need for separation during all his active professional life ? Apart from this Cheselden's knowledge of the intimate working of the Company would have informed him that the barbers outnumbered the surgeons by twenty to one, that most of the benevolent money came from the surgeons, and his knowledge of the increased number of surgeons needed by the increasing number of hospitals would have convinced him of the need for changes in surgical education which were not likely to be available under the old regime. It is tempting to assume that, during the time that his attendance at the Court almost ceased, he was already interviewing his many influential friends, having discussions with prominent surgeons (like Ranby) who were not on the Court, and preparing the ground for the act of separation. If he had not been a prime mover in the matter he would surely have been one of the joint committee chosen to consider the matter with the barbers. On any other view of the matter it would be difficult to understand why his friend and son-in-law, Dr. Cotes, should have been made chairman of a committee which included many prominent statesmen, and that he should have been the one chosen to draw up and present the Bill to the House of Commons. There exists one small piece of evidence that Cheselden himself may have done some lobbying. On February 5, 1744-5, the day before the barbers presented their counter-petition, it is recorded in the minutes of the Court of Assistants that the clerk of the Barber-Surgeons Company had to go to the Speaker's Chamber in order to pay a sum of money due to Cheselden. The entry runs: "gave Mr. Cheselden in the Speakers Chamber of the House of Commons £1 1 ls. 6d. as money left by him in my hands for diplomas." It has been said that " money talks." In this instance it speaks emphatically. To defray the cost of the legal and other proceedings incidental to the separation 52 surgeons subscribed five guineas apiece and 29 others subscribed a guinea. The total amount subscribed amounted to £303 9s. Od. But they needed more than double that amount, so Cheselden lent them five hundred and fifty pounds. No other surgeon lent anything. Cheselden was far too wise to seek to be the first Master of the new Company; he was content that Ranby should have that honour and there can be little doubt that Ranby, by his friendship with the King, must have made the passing of the Act more smooth. But Cheselden 10 THOMAS VICARY LECTURE became Master in the second year of the Company's life and it was in that year that active steps were taken to buy a suitable site and to build a new Surgeon's Hall. Moreover Cheselden brought before the Court plans which he had himself drawn up for the new hall, but these were considerably modified, first by the famous architect Kent, and later by a builder called Jones. To sum up my views on the main question: throughout his activc life Cheselden had always had before him the need for improved medical education and he considered that for this to be advanced a separation of the surgeons from the barbers was necessary. When opportunity offered he set everything in motion to achieve that separation, even to the extent of largely financing the transaction. The success of the movement betrays a master mind at work and that mind was Cheselden's. While these negotiations were proceeding Cheselden was living at the Royal Hospital, Chelsea, where his duties were light and enabled him to continue some private practice. He made many improvements in the hospital, segregated the surgical sick, engaged extra nurses and a watch- man for the surgical wards, effected many economies in what had previously been a very extravagant regime, and had a room specially prepared for carrying out post-mortem examinations. He also voluntarily limited his own perquisites, although we happen to know he was not a wealthy man. The reason we know this is because in 1743 the Lord Mayor nominated Cheselden as one of the Sheriffs for the City of London. It was customary for one of the Sheriffs to be chosen from among the Aldermen and the other from outside that select body of officials. Usually the Lord Mayor chose someone who was thought to be wealthy for if he refused the honour it was customary to fine him a considerable sum, about four hundred pounds, which would be equivalent to about £2,000 of our present money. The only way to escape the fine was to swear an oath that one's estate was under the sum of fifteen thousand pounds. Accordingly on 28th June, 1743, Cheselden " did voluntarily take his corporal oath that at the time of his said election nor since his estate in lands goods and separate debts did not nor doth now amount to the value of fifteen thousand pounds." He also brought with him six of his friends, who were freemen of the city and barber-surgeons, who supported his statement. " Whereupon the said William Cheselden was discharged from the said office for the year ensuing." Cheselden's will did not mention the sum he left, but the sum left by his widow amounted to about £12,000, which would confirm the accuracy of Cheselden's testimony. There remains one more incident of interest in the life of Cheselden. In 1748-9 he had as his pupil one who was destined to lay the secure foundation of surgical pathology-. It was Macaulay who said that William Cowper " was the founder of a dynasty illustrious in the history of science; for he was the teacher of William Cheselden and William Cheselden was the teacher of John Hunter." At this time Hunter was a 11 V. ZACHARY COPE youth of twenty years and Cheselden was sixty and past his prime, but I like to think that the veteran anatomist inspired the youth with some of his earlier enthusiasm. When William Hunter came to London in 1741 he acted as assistant to James Douglas who for many years had been a close friend of Cheselden. It is possible that James Douglas may have influenced William Hunter to send his brother John to sit at the feet of Cheselden. How eagerly we should read any authentic account of the converse between these two great men. Cheselden had now finished his life's work, and judging from the slower progress of the Surgeon's Company in building their hall, he seemed to have lost his energetic drive. He used to visit Bath from time to time, partly for his health's sake and partly for the practice he obtained there. Early in 1751-2 he visited that city and while there he was taken ill and died on April 10, 1752. The notice in the Gentleman's Magazine for April 11, 1752 was as follows: "1 Wm. Cheselden, Esq.; an eminent anatomist, lithotomist, and surgeon to the Royal Hospital, Chelsea; at Bath; he had drank ale after eating hot buns, upon which being very uneasy, he sent for a physician who advised vomiting immediately, which advice, had he taken it might, it is tho't, have saved his life." Cheselden was buried in the grounds of Chelsea Hospital. Can we imagine Cheselden as he actually was ? Was he the smooth and almost smug man we see in Richardson's portrait ? Or do we get a better idea of this eager, active man from the bust of Roubilliac which reveals his virility better than the portrait. Cheselden was a good natured and generous man. He presented a lovely silver cup to the Surgeon's Company which, by a fortunate chance and the generosity of the late Mr. Cecil Joll, is now once more in the keeping of this College. Cheselden must also have been well known in the north of England for his portrait with an inscription are to be seen on the face of a grandfather clock made at Otley and now in the possession of Sir Russell Wilkinson. Though severe criticisms were published concerning Cheselden's writings he did not prolong the controversy by answering these criticisms, and he was often broad-minded enough to adopt some of his opponents suggestions. Though perfectly calm while performing an operation he confessed that he often felt very nervous before he started to operate. Cheselden was friendly with leading men in all walks of life and. had many interests outside his profession. He had a taste for poetry and a flair for architecture, he was a patron of boxing and is said himself to have been an expert in that art. He was perhaps a little ostentatious, for it was said of him that he was prouder of his horses and equipage than he was of his international surgical reputation. He was a good family man. The affection which existed between father, mother and child can be judged from the request in the will of the daughter who died in 1763 and asked that her body should be laid to rest between those of her father 12 THOMAS VICARY LECTURE and mother in the vault which is covered by the well-known monument in the garden of Chelsea Hospital. We have made it clear, that Cheselden was the leading surgeon of his age, but he was much more than that. He was the first man to see the need, and to try to satisfy the demand for a scientific surgical education. He anticipated the regular clinical teaching of students in hospitals. When in the year 1724 he and his three surgical colleagues were called before the Grand Committee of St. Thomas's Hospital to be given a lecture because they had more pupils than were allowed, we can see the mind of Cheselden in their reply: " they hoped it would be looked upon as a great advantage to the publick to have so many young men improved in the art of surgery by their observations of the practice of this hospital." There surely we have the authentic attempt to improve medical education. Moreover Cheselden attempted to satisfy the demand for more regular scientific teaching. Before his time the teaching of anatomy had been perfunctory. He made it a necessary study for medical students, gave regular lectures and provided the necessary textbook. Moreover he mingled a good deal of elementary physiology in his anatomical lectures. Furthermore he joined forces with a physicist-Hawksbee junior-whom he brought in to teach the mechanical principles underlying anatomical function. He led the way for William Hunter, Abernethy, Charles Bell and Astley Cooper to follow. He it was who engineered the separation of the surgeons from the barbers, in his view a necessary preliminary to the progress of medical education. Three of his pupils got on the staff of either St. Thomas's or Guy's Hospital-, John Girle and John Belchier-and they carried on his tradition to the next generation. So, in the narrow confines of Crane Court, where Cheselden and Hawksbee gave their combined series of lectures, one can see the first imperfect beginnings of scientific medical education. The year 1752 is notable as the year in which the calendar was altered from the Julian to the Gregorian style; by surgeons, yes, and by all medical men it deserves to be remembered as the year in which William Cheselden, one of the pioneers of scientific surgical education, paid tribute to his mortality.

13 2-2