Frederick Henry Horatio Akbar Mahomed: ‘A Brave and Ambitious Explorer’

HISTORICAL REVIEW Frederick Henry Horatio Akbar Mahomed: ‘A brave and ambitious explorer’

O Lewis Foxcombe Hall, Boar’s Hill, Oxford OX1 5HR, UK

Keywords: Frederick Mahomed; sphygmograph; Collective Investigation Record

Frederick Henry Horatio Akbar Mahomed entered disease, and for modifications which he devised Guys Hospital, London, as a medical student in while still a student, to the sphygmograph, an 1869, aged 20. He already had some experience of instrument which registered the rate and character the medical world, having spent several months at of the beats of the pulse. the Sussex County Hospital and General Sea Bathing That the pulse could provide valuable insight into Infirmary in his home town of Brighton. The Hospi- a patient’s condition had been recognised from tal, which was close to the beach, had a supply of ancient times: until the 19th century, interpretation seawater pumped to it (a practice which continued depended heavily on the physician’s touch. The until 1876); thus the Hospital was able to offer its ancient Chinese described their pulse observations patients special seawater treatments, which the poetically ‘smooth as a flowing stream’; by the 13th young Mahomed may have helped to administer. century Arabian physicians recognised 10 ‘varieties’ Mahomed would also have known of the work of of pulse, recognising attributes such as the move- his grandfather, Sake (Sheikh) Dene Mahomed, who ment of the arteries and duration of the diastole and was appointed Shampooing Surgeon to George IV the systole. But it was not until the 19th century that and William IV. Sheikh Mahomed established the more sophisticated methods for assessing the pulse first Turkish baths in the country in Brighton at the were possible. By the late 1860s, a variety of sphyg- site of the present Queens Hotel on the King’s Road, mographs existed1 all of which had limitations (Figure 1), and offered a ‘shampooing’ (massaging) which made them difficult to use. In England, the service which became popular after several cures model in common use was of French design by the were reported, particularly of rheumatic conditions. physiologist and inventor, Etienne-Jules Marey.2 Sheikh Mahomed published a number of pamphlets The instrument had been brought to London in the and booklets on the therapeutic value of his treat- mid-1860s by the scientist and academic, John Bur- ment, many of which were doubtless familiar to the don Sanderson.3 It was soon observed that Marey’s young student. sphygmograph had shortcomings: reading the trac- Although his background would have marked him ings required considerable practice and, while it initially as an outsider in the world of traditional captured the waveforms of the pulse, it did not pro- medicine, Frederick Mahomed was to become a vide a measure of pressure.4 physician of outstanding ability, with exceptional Mahomed recognised the importance of the pulse: clinical and diagnostic skills. A man of commanding presence, with powerful intellect and unquenchable . . . first amongst our guides; no surgeon can energy, Mahomed was both practical and innovative despise its counsel, no physician shut his ears to in his approach to problems. His untimely death left its appeal. Since, then, the information the pulse his last initiative (the control of drugs) undeveloped, affords is of so great importance and so often con- but he had by then successfully developed the first sulted, surely it must be to our advantage to national survey in Britain of common diseases such appreciate fully all it tells us, and to draw from 5 as phthisis and pneumonia, namely the Collective it all that it is capable of imparting.’ Investigation Record. Although shortlived, this But, as he was aware, not all of the vital information novel exploration of aspects of disease attracted on the patient which the pulse could reveal was great interest both at home and abroad. Today, while immediately accessible. The Marey sphygmograph the Collective Investigation is largely forgotten, limitations were obvious,6 and the interpretation of Mahomed is remembered for his work on the pulse pressure by touch, even by experienced relationship between vascular condition and kidney hands, was inexact. Mahomed began work at Guy’s Hospital in the laboratory of the chemical pathol- Correspondence: Olive Lewis ogist, Frederick Pavy. He devised an adjustable Accepted 22 January 1997 spring which enabled the measurement of the press- Frederick Henry Horatio Akbar Mahomed O Lewis 256

Figure 1 Mahomed’s baths, Brighton. (Shampooing, SD Mahomed, Brighton, 1826).

ure of the pulse, and a London instrument maker ‘If all or some of these characters [from the ‘pro- was employed to construct the modified sphygmo- file’] are found in the pulse on the right side and graph from his design (Figure 2). Mahomed was not on the left, the aneurism is innominate; if in awarded the Pupils Physical Prize at Guy’s, and an the right and partly in the left, it is innominate account of the work, ‘The Physiology and Clinical and transverse arch; if in the left only it is trans- Use of the Sphygmograph’ was published in the verse or root of the subclavian; if the signs are Medical Times and Gazette of 1872. Requests for only partially present and equally on both sides, demonstrations followed, at which Mahomed was it is ascending arch; if all are strongly marked and able to show the practical value of the modified only on one side, it is probably directly in the instrument,7 both in the prognosis of patients with course of the subclavian, and not involving the heart disease and as a guide to the efficacy of treat- aorta.’ ments such as digitalis. Characteristic tracings of waveforms for each known form of cardiac disease Other practitioners continued to find that the tak- were provided for his audience to examine. ing and interpretation of readings from the sphyg- Mahomed developed considerable skill in taking mograph remained difficult despite Mahomed’s tracings8 and in interpreting the waveforms. He was improvements. Never very popular, its use was to able to identify a precise pattern or profile9 which decline with the introduction in the mid-1880s of indicated the presence of an aneurism and, very the sphygmomanometer. This new instrument meas- importantly where an operation to alleviate the con- ured pressure in the radial artery at the wrist, using dition was proposed, locate its position: an aneroid device similar to a barometer10 and gave

Figure 2 Mahomed’s sphygmograph. The apparatus, modified from that of Marey was made by jeweller and watchmaker Mr A Clarke of Forest Hill, South London, under Mahomed’s directions. (Old illustration, source unknown). Frederick Henry Horatio Akbar Mahomed O Lewis 257 an immediate quantitative measurement. The two which alters the relation between the blood and instruments, as Mahomed would have appreciated, the tissues, and destroys their chemical affinity did not measure the same phenomenon. While the for each other; or else to a sudden chill causing sphygmomanometer measured the level of the blood contraction of the superficial vessels and conges- pressure (BP) in the artery at a precise moment in tion of the internal organs. If this condition of time, the sphygmograph showed the duration and high tension be sufficiently severe, transudation features of the decline of the pressure, thus being of the characteristic crystalloids of the blood. . . the more informative of the two to the skilled prac- occurs before the albumen appears in the urine, titioner, such as Mahomed himself. and they can be detected in that fluid by the guai- Soon after qualification in 1872, Mahomed was acum test for blood. If this condition be allowed appointed to the London Fever Hospital as resident. to continue, albumen is subsequently found, and, Among the sick were many who displayed symp- if still unchecked or uncontrollable, Bright’s dis- toms of Bright’s Disease, and studying sphygmo- ease in one of its forms ensues. graphic tracings from these patients, he began to for- If checked before the albumen appears, or mulate a thesis about the condition. His interest in immediately after its appearance by a brisk purge Bright’s Disease may have been awakened by a lec- or other appropriate means, the condition is sud- ture given by Sir William Gull11 to Guy’s students denly changed – the tension disappears from the in 1872; as an able and industrious student, it is pulse and the crystalloids from the urine.’ unlikely that he would have missed this event. Gull described joint research with his colleague Dr HG As he was to put it in 1879: 12 Sutton, which they had already presented to the ‘. . . the cardio-vascular changes must be more Royal Medical and Chirurgical Society,13 on chronic important and more constant than any others; and Bright’s Disease. At the time, the favoured expla- this clinical aspect of the question would seem to nation for the condition remained that of Richard lend strong confirmation to Sir William Gull’s Bright from whom the condition took its name, in and Dr Sutton’s hypothesis of arterio-capillary which the renal failure was the primary factor. Gull fibrosis, and itself to gain strength from this and Sutton thought otherwise, proposing that the hypothesis and the evidence upon which it rests. renal aspect was secondary, and that the primary It appears to me that these clinical, and their disease was of the blood vessels, where a degenerat- pathological observations must stand or fall ive process occurred which they named ‘arterio- together; that one is the pathological, the other capillary fibrosis’. Their research was based on the clinical aspect of the same condition. Of this microscopic examination of blood vessels in the I feel sure, that the clinical symptoms and the pathological laboratory and their findings were hotly pathological changes resulting from high arterial contested; some colleagues publicly expressing pressure are frequently seen in cases in which doubt as to their ability to draw the correct inference very slight, if any disease is discoverable in the from their samples. kidney . . .’16 In his seminal paper ‘The Aetiology of Bright’s Disease and the pre-Albuminuric Stage’14 published Thus Mahomed’s clinical observations confirmed in 1874, 2 years after the Gull and Sutton contro- the findings described from post mortem data by 17 versy, Mahomed described one of his earliest obser- Gull and Sutton. The condition was, he recog- vations with the sphygmograph: nised, difficult to diagnose, as it occurred in widely differing conditions (such as pregnancy, high fever ‘that the pulse of acute Bright’s disease closely and anxiety states), as well as in apparently heal- resembles that which had previously been thy people: described and illustrated by the sphygmograph as occurring in chronic Bright’s disease, or more ‘These persons appear to pass on through life strictly speaking, with cirrhosis of the kidney. pretty much as others do and generally do not suf- Both conditions were accompanied by a pulse of fer from their high blood pressures, except in high tension. . . and especially was distinguished their petty ailments upon which it imprints by a prolongation or undue sustension of the itself. . . As age advances the enemy gains tidal wave.’ strength. . . . perhaps the mode of life assists him – good living and alcoholic beverages. . . or In a sequence of papers published in 1879,15 Mah- head work, mental anxiety, hurried meals, con- omed described fully his clinical observations on stant excitement. . . tend to intensify the exiting the condition, and set them into the context of earl- condition, or if not previously present perhaps to ier work by Burdon Sanderson, Broadbent and produce it. . . the individual has now passed forty others. But his paper of 1874 clearly shows he had years, perhaps fifty years of age, his lungs begin already recognised that high BP existed as a separate to degenerate, he has a cough in the winter time, event, and was the precursor and cause of albumi- but by his pulse you will know him. . .. Alterna- nuria, rather than the reverse: tively headache, vertigo, epistaxis, a passing par- alysis, a more severe apopleptic seizure, and then ‘That previous to the commencement of any kid- the final blow.’18 ney change, or to the appearance of albumen in the urine, the first condition observable is high This patient profile, so vividly described by Mah- tension in the arterial system, due either to the omed, is recognizable today. presence of a noxious material in the blood. . . Mahomed’s work on BP was well known to his Frederick Henry Horatio Akbar Mahomed O Lewis 258 contemporaries through frequent contributions at Park Hospitals, each of which was passed rapidly meetings of professional associations, which were across a sensitive plate, so that one photograph was widely reported in the medical press. By modern finally formed which was a compound of all the times however, it has almost been forgotten: one rea- others. The anticipated result was that a represen- son may have been that Mahomed’s professional tation of a typical phthisical patient would be career was too short to allow him time to consolidate obtained, but as the published report shows the out- his work into a form which would secure a place on come was disappointing, resulting in a bland fea- the library shelf. And the significance of his work tureless face ‘every indication of individuality hav- may have been lost by careless quotation or ing been obliterated.’ But even before the interpretation, notably by Clifford Allbutt,19 the publication of the paper with Galton in 1881, Mah- prominent Victorian physician and academic who omed had begun work on an important new venture. had become an authority on the condition of hyper- This short lived project, under the auspices of the tension by the end of the century. The difficulty in British Medical Association, became known as the reproducing Mahomed’s results with the sphygmo- Collective Investigation Record. The Record was to graph may also have been a factor; his skill with the be the main focus of his life until his untimely death instrument was exceptional, and few could have in 1884. achieved the same degree of expertise. However, In January 1880, the British Medical Journal pub- interest in his sphygmographs has recently been lished a paper entitled ‘Suggestions concerning the revived, and it has been acknowledged that he scientific work of the association’. Here, Mahomed anticipated, by some 100 years, modern work on BP set out proposals for the collection of data on disease and the process of aging.20 on a nationwide basis. As he put it: In 1877, an important ambition was fulfilled for ‘There are questions which come before us every Mahomed: he returned to Guy’s Hospital as a medi- day, apparently of the simplest nature, yet which cal registrar, an appointment he was to hold until no man appears able, from his own individual his death. Soon after his appointment to Guy’s, he experience, to answer to anbody’s satisfaction; decided to read for a British medical degree. One but which would apparently readily be solved if can speculate on his reasons for taking on the heavy a single year’s experience of the members of the burden of such study, but ambition was probably the Association, or of a large proportion of them, significant factor. Although holding an MD from could be obtained.’ Brussels (1874), he would have known that in a status-conscious profession, the acquisition of a He suggested that the British Medical Association Cambridge or Oxford degree would be of inesti- should conduct surveys, using standard question- mable value in attracting the best hospital appoint- naires designed to elicit the factual rather than the ments or the most wealthy and influential patients. opinion on such topics as the nature of the common He chose Cambridge – a University which, under the cold, incubation periods or relationships between influence of the physiologist, Michael Foster,21 had groups of diseases. Mahomed’s suggested question- adopted some of the most modern ideas in the teach- naire covered physical characteristics including ing of medicine from German Universities during sight testing, and sphygmographic, spirometric and the 1870s. In 1881, the degree of MB was conferred dynamometer readings. As well as providing upon Mahomed for a thesis entitled ‘Chronic answers to questions which had vexed his pro- Bright’s Disease without Albuminuria’.22 For 4 fessional colleagues for some time, he thought that years, from 1877 until 1881, he travelled between ‘a deeper scientific interest would be diffused London and Caius College, Cambridge, for formal throughout the profession. . .’ and ‘. . .it would be study and to fulfill the necessary residential require- brought home to each man that he owed a duty to ments for a Cambridge degree. But despite the medicine as a science, which he was bound in hon- additional burden imposed by his Cambridge stud- our to render in return for the privilege of using her ies, he continued to make contributions to dis- as a trade’. He was also interested in a more general cussion of medical issues of the day. The medical question concerning the predisposing factors which press of the time testifies to his regular attendance caused illness within individuals. Relationship at professional meetings, not in a passive capacity, between temperaments (in the old physical sense of but as an active contributor. He can be heard offering the word) and diatheses was much discussed among factual evidence based on his own clinical experi- the medical profession, and had been touched upon ence or perceptive comment on such diverse matters by Mahomed himself in his papers on Bright’s Dis- as the gynecological,23 scarlatinal convalescence,24 ease. It was generally accepted that race, climate, and tumours.25 He was willing to report on trials and mode of life, affected individual mental and with untried or relatively risky methods to treatment physical development: this same mental and physi- where his patient was in extremis:26 for example the cal condition might then affect the type or class of unsuccessful use of direct blood transfusion for disease to which an individual was liable. If several typhoid fever, where severe haemorrhage had generations were subject to the same conditions, occurred.27 Mahomed reasoned, the characteristics induced As his Cambridge studies neared completion, would become more marked, and ‘temperaments’ Mahomed joined Francis Galton28 on a project on formed which would then be associated with certain the use of composite photography in the diagnosis types of disease. To prove or disprove this hypoth- of phthisis.29 Hundreds of photographs of phthisis esis, family medical history needed to be accurately sufferers were taken at Guys, Brompton and Victoria recorded and the proposed survey was a means of Frederick Henry Horatio Akbar Mahomed O Lewis 259 achieving this end. (Mahomed was to flesh out this idea in a later article, in which he acknowledged the work of Francis Galton on photographic and anthro- pometric records.30) This research could specifically provide important evidence in the contemporary debates on cell theory and Darwinian evolution; thus Mahomed suggested that his project was ‘con- sonant with all the most advanced teachings of science as to the origin of species, the differentiation of cells and the transmission of hereditary tenden- cies.’31 He hoped that the information collected would be the means of encouraging a system of per- manent medical supervision, which would provide benefits to the patient as well as to medical science. He envisaged a ‘scientific registration of disease’ which he believed would be of immense value to the community.32 The paper was discussed in the correspondence columns of the British Medical Journal,33 generating much enthusiastic, but also some negative comment. The British Medical Association found the proposal sufficiently attractive to set up a committee to examine it, and it was quickly recommended that Maho- med’s proposals be adopted. In April 1881 the Brit- ish Medical Association formally began to organise, through the Collective Investigation Council, the collection of data on the lines suggested and the first Secretary, Dr WR Smith of Cheltenham, was appointed to the project in October 1881. Smith’s tenure was short and from February 1882, Mahomed took on the role of Honorary Secretary. As Professior Humphry,34 a future Chair of the project was to remark later, ‘Mahomed threw himself heart and soul into the project.’35 Immediately, a new vitality and urgency was injected into the proceedings: in March 1882, all British Medical Association members were invited to contribute ‘his mite for the common good and for the advancement of medicine.’ The project’s Council decided that the initial inves- tigations should concentrate on acute rheumatism, chorea, and pneumonia, and in the case of the latter, whether links with other diseases or with sanitary conditions existed. At frequent intervals, memor- anda outlining the objectives for research into the chosen topics appeared in the British Medical Jour- nal,36 a sample of standard record form for the collection of personal details was usually included (Figure 3). By mid-1882, local groups of the British Medical Association across the British Isles had agreed to participate. During the spring and early summer of 1882, Mahomed commenced an energetic campaign to encourage further support, personally visiting a number of branches, and writing to others. On visits to local branches, Mahomed was careful to empha- Figure 3 Sample of a standard record form for the collection of sise the practical value of the records which local personal details. Published in the British Medical Journal,16 practitioners could provide, and the importance of December 1882 (Br Med J 2: 1229–1230). their contribution:

‘They had in hospitals excellent opportunities of this sort with regard to organic disease, and they observing terminations of organic disease. . . but wanted to know what diseases prevailed in cer- practitioners all over England had an opportunity tain districts, and to put the observations to the of observing these people for years before their test. Also they wanted to know the diseases kidneys etc became diseased. They wanted prac- among certain operatives in certain districts, and titioners to give them the life history of patients of to know the special diseases of every trade. Obser- Frederick Henry Horatio Akbar Mahomed O Lewis 260 vations from all parts of the country must tend to medical practitioners alike were attracted by the benefit medical science.’37 homeopath’s practice39 of dispensing small, elegant doses in the form of drops or granules rather than He suggested that in the future the physician would the grosser remedies of contemporary orthodox be paid to prevent disease, and not as at present be medicine. Some patients attempted self-medication called in to cure the incurable: with patent preparations, the content of which was ‘We want to teach our patients how to live to give often unknown. The less scrupulous practitioners, them healthy surroundings, and to protect them the ‘quacks’, were able to easily deceive patients by from unhealthy habits and occupations; then to bogus science, using invented terms to explain the watch and treat their minor ailments; and so ward treatment. Respectable medical practitioners felt off, as long as possible, grave organic disease.’ deterred from using new drugs, for fear of giving the ‘quacks’ some credibility. Setting out his concerns Mahomed’s words reflect the changing emphasis in in a letter to The Lancet, published on 4 October late 19th century medicine towards preventative 1884, Mahomed suggested that the simple repeal of medicine, and the beginning of the role of the family the contemporary Patent Medicines Stamp Act and doctor as friend and advisor to the families in his regular revision of the standard Pharmacopoeia care. (introduced to Brtain in 1864) would not strike at From late 1882 regular reports of numbers of com- the heart of the problem. He put forward a novel pleted forms were published in the British Medical scheme: all medicines, including homeopathic rem- Journal. The returned questionnaires were quickly edies and foreign preparations, should be hall- analysed and edited by Mahomed and Professor marked by an official pharmaceutical assay depart- Humphry. Reports on pneumonia, chorea, acute ment, under the aegis of the government. The rheumatism, diphtheria, and on the communic- prescribing of unmarked drugs would then become ability of phthisis were published in 1883 as Vol- illegal. The scheme was to be funded by a charge ume 1 of the Collective Investigation Record, which for testing, which Mahomed thought would result received much praise and for a time was regularly in considerable surplus revenue for the government. quoted in medical writings. The project achieved its The British Medical Association again supported apogee at the International Medical Congress in Mahomed’s initiative and set up a committee to Copenhagen in August 1884, when discussion of the review the scheme and to report back by January British achievement was a prominent item on the 1885; further, it was promised that the subject agenda. As the spokesman for the British delegation, would be one of the themes for the 1885 Annual Sir William Gull put forward a proposal for an inter- General Meeting. Mahomed also tried to enlist the national Collective Investigation on similar lines to support of the Royal College of Physicians, whom the British. The Congress was receptive; similar pro- he considered had a duty under its Charter to under- jects were already under consideration in Russia and take a leading role in the regulation of drugs. But France, and the Berlin Medical Association had he was to be disappointed by their negative reaction already set up a similar survey, but, in contrast to when he put his proposals to the vote at a meeting the British model, had chosen to concentrate on one at the Royal College on 30 October 1884. topic, phthisis. The Congress endorsed the proposal The year 1885 was full of promise. There was to found an International Collective Investigation, much work to be done to move the drug project for- and established a planning group, of which Mah- ward in time for the 1885 Annual Meeting of the omed was appointed a member of the British del- British Medical Association. For Mahomed person- egation along with Humphry and Isambard Owen.38 ally, there was an invitation to give the recently Shortly before the Congress in July 1884, Mah- established Bradshaw Lecture. But it was not to be. omed relinquished his role as working secretary to On the evening of 30 October, after the disap- the British Collective Investigation but retained his pointing meeting at the Royal College, Mahomed fell honorary status. Although the new Secretary, Dr ill. Over the next few days it became apparent that Herringham, tried to maintain the momentum, inter- he had contracted typhoid, probably from one of his est had already begun to wane, as fewer completed patients at the Fever Hospital. During the early questionnaires were being received. The loss of stages of his illness he commended cold bath treat- Mahomed’s immediate enthusiasm and energy must ments for himself, such as he had found useful for have been keenly felt. Although its critics agreed his own patients, but his condition did not appear that useful work had been done, comments on the serious enough for his physicians to take this step. scale, over-ambition and high costs of the Collective Despite the care of his friend and colleague, Dr Investigation became more frequent over the next 5 Broadbent, his condition deteriorated, and he died years. It was finally laid to rest by Professor in the early hours of 22 November 1884. Humphry at the August 1889 Annual Meeting of the Frederick Mahomed’s professional career lasted British Medical Association in Leeds. just 15 years. His obituarists express very poignantly During the summer of 1884, Mahomed became the deep sense of loss of such a promising and tal- engaged on a new project: the effects of the growing ented young physician. A ‘brave and ambitious practice of homeopathy on drug therapeutics. Home- explorer in the regions beyond’ are the words of one, opathy had remained popular throughout the 19th using the metaphor of terrestrial exploration for century among the rich and poor; for the latter, the Mahomed’s pioneering work on hypertension, and druggist or herbalist was often the only affordable on the Collective Investigation, which was indeed treatment. But Mahomed believed that patients and the forerunner of modern epidemiological study. Frederick Henry Horatio Akbar Mahomed O Lewis 261 References 217. Nichols WW, O’Rourke MF, McDonalds Blood Flow in Arteries, London, 1990, and Freis, EH et al, 1 Chelius’s, using mercury, Naumann’s, water, and yet Changes in the carotid pulse which occur with age and another town gas or hydrogen from a portable gas- hypertension. Am Heart J 1966; 71: 757–765. ometer. A combination instrument, which measured 21 Michael Foster (1836–1907), physician and tutor at respiration and circulation, the stetho-sphygmograph University College, London, and Praelector in Physi- had also been devised by Hawksley. See The Physi- ology at Trinity, Cambridge Foster established the ology and Clinical Use of the Sphygmograph. Medical Cambridge school of physiology in the early 1980s; Times and Gazette 1872; 1: 62. under his guidance physiology became a precise 2 Etienne Jules Marey (1830–1934) The sphygmograph experimental science, firmly based in physics and was the subject of his first paper, published in 1860 in chemistry. Comptes Rendues of the Academie des Sciences. Mar- 22 Guys Hospital Reports. 1881; 15: 295. ey’s later inventions included the cine camera, and he 23 Case of intestinal obstruction produced by the abnor- was the first scientific cinematographer. mal remains of a foetal vessel. Trans Path Soc 26: 117. 3 Sir John Burdon Sanderson (1828–1905), trained at 24 A contribution to the clinical history of scarlatinal Edinburgh, held one of the first appointments as Medi- convalescence. Practitioner 1875; 15: 21. cal Officer of Health in Paddington, London; elected 25 Primary cancer of the undescended testis, cancer of FRS, undertook research at University College London; the thymus, vacuolation of liver and kidneys. Trans later appointed Professor of Practical Physiology and Path Soc 1883; 34: 182; Two cases of pulsatile tumour Histology at London, subsequently moved to Oxford. at the root of the neck. Guys Hospital Reports 1883; 4 One contemporary sphygmograph designed by Karl 41: 83 with CH Golding-Bird. Vierordt, was able to measure pulse pressure but was 26 He also tried what would now be regarded as bizarre a rather complex apparatus, with scale and weights. treatments: he is reported to have sought permission 5 The physiology and clinical use of the sphygmograph. from the hospital governors to sanction the purchase Medical Times and Gazette 1872; 1: 62. of sheep, so that he could wrap fever patients in the 6 Various improvements had been suggested: the use of warm sheepskins, immediately on their removal by the smoked glass instead of paper to improve the quality butcher. The idea was not implemented, as he had of the tracings, a means of affixing the instrument more already devised an improved treatment, the use of a securely to the patient’s wrist. The Lancet 1867; 1: 499; tent with steam supply, to provide a vapour bath. 1869; 1: 406. 27 Two cases of direct transfusion of blood for haemor- 7 For example, at the May meeting of the West Kent rhage in typhoid fever. Trans Clin. Soc London, Nov- Medico-Chirurgical Society, reported in The Lancet ember 1881; 15: 50, also The Lancet, 1881; 2: 950. 1873; 1: 773. 28 A paper on Photographic Chronicles and Anthropo- 8 Some of the tracings were used by Sir William Broadb- metric Laboratories published in the Fortnightly ent (1835–1907), in his classic text The Pulse, 1890, Review during 1882. after Mahomed’s death. Broadbent, a lecturer in com- 29 An enquiry into the physiognomy of phthisis by the parative anatomy and medicine held appointments at method of composite photography. Guys Hospital London Fever and St Mary’s Hospitals. Reports 1881; 40: 475C. 9 Mahomed identified the following characteristics as 30 Mahomed F. On Medical Life Histories. Br Med J 1882; indicative of the presence of an aneurism: diminution 2: 1296. in volume of the pulse wave; a sloping upstroke; 31 ‘Suggestions. . .’ Br Med J 1880; 1: 31. impairment or annihiliation of percussion impulse; 32 Mahomed’s purpose was later clarified as clinical and partial or complete obliteration of dicrotic and other not sanitary in nature, to avoid confusion with the secondary waves; generally dimunition but sometimes recently established Medical Officers of Health, whose increase of amount of pressure required to produce the duties involved the compilation of statistical data, as tracing. Report of a meeting of the Clinical Society of well as the investigation of sources of infectious dis- London, held on 9 February 1877, BMJ 1877; 1: 203. ease. Br Med J 1880; 1: 74. 10 This in turn gave way to a sphygmanometer which 33 For example, Arthur Ransome’s paper, ‘On the Need of measured pressure in the brachial artery against a col- Combined Medical Observation’. Br Med J 8 Oct 1864. umn of mercury. 11 William W Gull (1815–1890), clinical physician and 34 Humphry, Sir George (1820–1896), FRS, Professor of lecturer at Guys hospital; also appointed as physician Anatomy at the University of Cambridge, Surgeon to to members of the Royal Family. Addenbrookes Hospital, Cambridge. Actively involved 12 Sutton, HG (1836–1891), teacher, pathologist and in the work of the British Medical Association, British physician at London Hospital. Association for the Advancement of Science, The Ana- 13 Discussion reported in The Lancet dated 8 June 1872. tomical Society of Great Britain and the Pathological 14 The Aetiology of Bright’s Disease and the Pre-Albumi- Society. nuric Stage. Med Chir Trans 1874; 57: 197. 35 Obituary. Br Med J 1884; 2: 1099. 15 On Chronic Bright’s Disease and its essential symp- 36 For example, the memorandum on Diptheria, appear- toms. The Lancet 1879; 1: pp 46, 76, 149, 261, 399, ing in the Br Med J 1882; 2: 1174. 437. 37 Address to the South Western Branch of the British 16 ibid, p 437. Medical Association, in June 1882. Br Med J 2: 115. 17 Samuel Wilks, (1824–1911), lecturer on pathology and 38 Isambard Owen (1850–1927), Dean of St George’s medicine at Guys Hospital. Medical School; interested in medical education; 18 The Lancet 1879; 1: 400. moved into education administration after 1884. 19 Allbutt, Sir Thomas Clifford (1836–1925), Regius Pro- 39 The founder of modern homeopathy, CFS Hahnemann fessor of Physic at Cambridge, editor of System of (1755–1843) had conducted drug trials to ascertain Medicine (1896–99), noted for work on use of the exact effects on patients, from this the homeopathic opthalmoscope, the short-stemmed thermometer, and law of infinitesimals was developed, in which the effects of syphilitic disease on the arteries. principle that the smaller the dose, the more effective 20 Quoted in O’Rourke MF. Hypertension 1992; 19; 212– it will be was enshrined. Frederick Henry Horatio Akbar Mahomed O Lewis 262