The Two Heberdens (Part II, Conclusion)
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THE TWO HEBERDENS WILLIAM HEBERDEN THE ELDER (1710-1801) WILLIAM HEBERDEN THE YOUNGER (1767-1845) By SIR HUMPHRY ROLLESTON, BART., G.C.V.O., K.C.B., M.D. HASLEMERE, SURREY, ENGLAND (Conc lus ion ) * (14) “A letter to Dr. Heberden con- Life of Jenner, did not reach Heberden cerning the Angina Pectoris; and Dr. who certainly never referred to the sub- Heberden’s Account of the Dissection of ject. Jenner did not publish the coronary one who had been troubled with the origin, out of consideration for Hunter disorder” (3: 1-11, 1785). Read at a who, however, was probably fully aware meeting on November 17, 1772. The of the association of coronary disease and letter dated April 16, 1772, was signed angina, and of the true nature of his own by “Unknown” who, having seen in the symptoms. For in 1776 Fothergill pub- Critical Review an abstract of Heberden’s lished a fatal case in which Hunter in paper (read in 1768 and published in 1775 had found that “the two coronary 1772), recognized his own symptoms and arteries from their origin to many of their described them in a way which the late ramifications in the heart were become Sir William Osler regarded as one of the one piece of bone.” Jenner sent his friend best on record. Realizing that he might Caleb Hillier Parry (1755-1822) a full die suddenly “the unknown” left direc- written statement of his opinion that tions that Heberden, who by this time coronary disease was the cause of angina, had seen 50 cases, should then examine pointing out that he did not wish to make his body. Three weeks later this was done it known because of his affection for John by John Hunter who found nothing Hunter. In 1788 Parry read a paper more than small areas of calcification in embodying this view to a small medical the aorta; Edward Jenner, however, who club, consisting of Jenner, Hicks of was present, wrote to Caleb Hillier Parry, Bristol, Paytheran, Ludlow and himself, “I can almost positively say that the which met three times a year, usually coronary arteries of the heart were not at the Fleece Inn, Rodborough, Glou- examined.” It may be added that in the cestershire, and is therefore sometimes spring of the following year John Hunter spoken of as “The Fleece Medical So- had his first attack of angina pectoris, ciety.” This paper was not published, but which was so graphically described by his in 1799 Parry incorporated its contents, nephew Sir Everard Home; in May, 1777 including Jenner’s statement, in “An he had a second attack, and Jenner, who Inquiry into the Symptoms and Causes soon after saw him when convalescing at of Syncope Anginosa, commonly called Bath, had in the meanwhile seen two Angina Pectoris; illustrated by Dissec- post-mortems on patients with angina tions.” There are resemblances between and coronary disease, one of them appar- Heberden and Parry; they were both ently of coronary thrombosis. In .1778 constant and copious notetakers, and left Jenner wrote a letter to Heberden giving behind them works which posthumously his diagnosis of angina and, for the first added to their already high reputations, time, stated that the underlying cause the “Commentaries,” from the senior was coronary disease. For some reason or and the “Collections from the Unpub- other this letter, reproduced in Baron’s lished Writings of the late Caleb Hillier * Part 1 appeared in the September issue, n.s. 5: 409, 1933. Parry” (3 vols., London, 1825), which 80 additional cases. A parallel and contained his account of exophthalmic closely related event is the frequency goiter. with which the clinical picture of (15) “The Method of preparing the coronary thrombosis has been recog- Ginseng Root in China” (3: 34-36, nized within the last ten years. The 1785). Communicated by Heberden for John Burrow on November 11, 1773. two descriptions in 1768 and 1782 do (16) “Of the Measles” (3: 389-406, not differ in essentials, but there are a 1785). Read on August 6, 1785. This was few differences in details. Heberden the last professional paper published by regarded angina as a spasmodic and Heberden during his lifetime. not as an inflammatory affection, and in a footnote in the “Commentaries” Of these sixteen papers the out- seems to confuse with it the mountain standing are those on chicken-pox and sickness described by H. B. de Saus- angina pectoris as they give the first sure in 1779. Careful estimates of complete descriptions of these dis- Heberden’s account of angina pectoris eases. In the first of these two he have been given by Gairdner and by pointed out precisely the diagnostic Osler. points from smallpox. The last volume of Medical Obser- In the classical description entitled vations and Inquiries by a Society “Some Account of a Disorder of the of Physicians in London (6: 340-407, Breast” he wrote: “The seat of it, and 1784) contained “A Sketch of the sense of strangling and anxiety with Epidemic Disease which appeared in which it is attended may make it not London towards the End of the Year improperly called angina pectoris,” 1775” to which thirteen medical men, and he spoke of it as “a distemper including Heberden, Sir John Pringle hitherto so unnoticed, that it has not, (1707-1782), H. R. Reynolds, and as far as I know, found a place or a Sir George Baker contributed. In name in the history of disease.” his paper dated December 16, 1775, Descriptions of isolated cases, such as Heberden said that the epidemic be- those of Seneca, the Earl of Claren- gan about October 28. In this sym- don’s father, and patients of Mor- posium there was also a letter addressed gagni, F. Hoffmann (1734), and to John Fothergill (1712-1780) who Rougnon (1768) of Besangon, have stood in much the same parental since been unearthed; Huchard urged relation to these Medical Observations the claims of Rougnon (which have and Inquiries as Heberden did to been discounted as based on a case of the Medical Transactions of the Royal cardiac dilatation in emphysema), College of Physicians. Both these and the eponym “Rougnon-Heberden publications ceased after their sixth Krankheit” has been employed. In his volume, and it would seem probable “Commentaries” Heberden described that the number of years which were the disease under the heading of allowed to intervene between the Pectoris Dolor and said that he had reading and the printing of the papers seen nearly a hundred cases, so that must have led to their extinction. in the interval between the reading of The great contest between the fel- the original paper in 1768, based on 20 lows and the licentiates, who were cases, and 1782 when the “Commen- agitating for admission to the exami- taries” were finished he had seen some nation for the fellowship, of the Royal College of Physicians of London, defi- and Sir John Pringle, in favor of nitely began about 1752, “although admitting John Fothergill, arch-rebel the first mutterings of the storm were though he was, as a fellow; the heard as far back as 1746” (Chaplin), proposal was lost by 13 votes to 9. and continued with occasional ex- Another licentiate who vigorously and acerbations until the beginning of ably advocated the reform of making Queen Victoria’s reign. The licentiates the licentiates eligible for the fellow- were vigorous, not to say rough, in ship was W. C. Wells (1757—1817), their methods; on September 24, 1766, author of the famous “Essay on Dew” they forced their way into a Comitia (1814). He supported Dr. Christopher when Sir William Browne (1692-1774) Stanger in his action at the Court was president, and on September of King’s Bench in 1796 by a long 30 of the following year they were and spirited letter of 186 printed prevented from doing so only by pages, but not published, dated July the locked iron gates, to force which 1, 1799, to the Right Hon. Lloyd, Lord they in vain offered a smith 10 Kenyon (1732-1802), Lord Chief Jus- guineas and an indemnity of £300. tice: “Relative to some Conduct of After a number of actions at law and the College of Physicians of London much pamphlet warfare the licentiates posterior to the Decree of the Court were in the nineteenth century ad- of King’s Bench in the case of Dr. mitted to the examination for the Stanger.” In it he paid a high tribute fellowship without being doctors of to Heberden: medicine of the Universities of Oxford or Cambridge, a requirement dating Many of our physicians have no doubt from about 1575. The anonymous received little injury from the causes of author of the “Picture of the present the corruption of character to which they State of the Royal College of Phy- were exposed; and some few have escaped sicians of London” (1817) advised their influence altogether. One of these few, Dr. William Heberden, I must con- the licentiates to concentrate and clude to have been known to your elect their own president. Times have Lordship, from the eulogy which you greatly changed since the eighteenth passed upon him during the trial of Dr. century, in the last year of which Stanger’s cause. Dr. Heberden, my Lord, there were only 45 fellows of the stands in a manner alone in his profession. College, for in 1876 the largest number No other person, I believe, either in this of fellows hailed from Edinburgh or any other country, has ever exercised closely followed by the University the art of medicine with the same dignity of London, and then came Cambridge, or has contributed so much to raise it in Oxford, and St.