DANIEL WHISTLER AND HIS CONTRIBUTION TO PEDIATRICS By H. P. TAIT, M.D., F.R.C.P.Ed., D.P.H. Assistant Medical Officer of Health, Edinburgh of On i 8th October 1645 there was read at Leyden the Latin thesis young Daniel Whistler for the degree of Doctor of Physic. The importance of this thesis lies in the fact that it contained the first the complete clinical account of rickets, and preceded by five years monumental and authoritative work of Francis Glisson and his colleagues. Prior to Whistler's description there had been no clear account of rickets. That the disease was not unknown to the ancients is shown by the allusions to it in the writings of Soranus of Ephesus (second century A.D.), and in Galen's De morborum causis (Findlay, 1934-)- Foote (1927), from a study of the later fifteenth and sixteenth century paintings by Netherlands and German masters, demonstrated the existence of rickety deformities in these times. Hieronymus Reusner to published at Basle in 1582 a description of a disease confined children and characterised by weakness of the limbs, chest deformities and bow legs. This disease, obviously a brief description of rickets, Reusner stated was common in Switzerland and Holland. With the no clear-cut earlier writers, however, there appears to have been very other conception of rickets, and it was doubtless confounded with diseases affecting the skeleton in children (Still, 193 0- Yet it: 1S remarkable that no adequate description of rickets was published before 1645. The word rickets was apparently first used in England about a Bill of 1625, and it appeared as the cause of fourteen deaths in Mortality dated 1634, while the word rickety was not in use until 1738 (Brown, 1942). A.?Whistler's Description of Rickets of Whistler's book was published a short time after the reading his thesis in 1645. It was a small quarto volume of some eighteen pages, though when it was reprinted in 1684, it was in octavo. Copies of the 1645 edition are very rare, but there is a copy in the Library of the Royal College of Physicians of London and another in the British Museum. The " title-page bears the heading : De morbo puerili Anglorum quem patrio idiomate indigenae vocant The Rickets . ? discutiendam proponit Daniel Whistler, Anglo-Saxonicus-Orientalis," and shows VOL. liii. no. 6 ,?c x 2 326 H. P. TAIT that the disputation was held at Leyden by authority of the Rector, the Reverend Dr John Polyander a Kerchoven, for the Degree of Doctor of Physic. Near the bottom of the title-page is a woodcut of a bird which Moore (1884) considered to be a representation of an ostrich holding Moore also a horseshoe in its beak. suggests that the bird's supposed ability to digest iron appealed to Dutch booksellers so that they thought it "an appropriate symbol of the capacity for assimilating knowledge in its toughest form." Below this symbol is the place, Leyden, the name of the publisher, Wilhem Christian Boxius, and the date of publication, 1645. The reprint of 1684, published just omits the prior to Whistler's death, woodcut of the bird. The reverse side of the title-page bears the dedication to two members of the Whistler family. Fourteen pages are devoted to the essay, which is divided into seventeen sections. The following is a brief summary of the text in modernised terminology : In Section I, note is made of the fact that the disease is common in England. Section II informs us that the ancients knew the symptoms of rickets but as disconnected phenomena and not, as Whistler says, " The syndrome of signs making in conjunction one pathognomonic " whole (Still's translation). He also observes that for the previous " twenty-six years, more or less," the disease had been known and " " that the name rickets may have been derived from the name of some quack who first treated the disease, or that it was a corruption " " of the Dorsetshire word to rucket or breathe with difficulty. " Whistler himself proposes the name Paedosplanchnosteocaces," which fortunately never came into use. The seventeen cardinal symptoms and signs of rickets described by Whistler occupy the next section. These are :?(a) abdominal distension ; (b) enlarged epiphyses, especially those of the arms and feet ; (V) rickety rosary; \d) general muscular hypotonia ; limb deformities ; lumbar kyphosis, later followed by an inability to sit up if the disease is progressing ; (e) large head, often with hydro- cephalus ; (/) flabbiness of the soft parts and abnormal flexibility of the joints; (g) delayed dentition which is often troublesome, with early decay of the erupted teeth ; (h) narrowness of the chest, pigeon breast or depressed sternum ; (i) increasing dyspnoea, often with cough ; (/) slow fever ; (k) feeble and irregular pulse ; (/) urine ; (m) often diarrhoea and vomiting ; (n) variable appetite ; changes " (0) normal sleep, unless something prevents it; (p) philosopher's mien, though those with large heads are dull ; (ff) pustules and blotches of the face, chest and limbs. In subsequent sections, Whistler describes, very inadequately and without first-hand knowledge, the post-mortem appearances in rickets, and speculates on the pathology of the disease. He is of the opinion DANIEL WHISTLER AND HIS CONTRIBUTION TO PEDIATRICS 327 that rickets is due to the clot-forming part of the blood becoming impacted in the viscera, while the serous portion is set free in t e whole body, the causing various swellings of the abdomen, epip >ses and head, and contributing to the general flabbiness of the tissues. A full definition of the disease in eight lines, all in italics, an reiteration of the main . points of pathology occupy Section / Sections XII to XV are taken up by a discussion of the causes ot some of the major symptoms and signs. is Prognosis epitomised in Section XVI, under the o owing heads All :?(a) die who are at or ema es affected before birth , (0) recover quicker than males ; (c) those with hydrocephalus succum , those (d) who bear movement easies of the body best recover , (e) those whose feet are attacked are easily cured, as are tiose w > are attacked at a more advanced age; (/) those who can scarce y hold up their heads and those who have much dyspnoea rarely recover , with of suppuration the lungs, never ; (g) a small, unequal an rapi pulse, a especially weak one, is a bad sign. The last section, occupying two and a half pages of text, ea with and treatment, Whistler recommends of a wide variet}. The drugs summary of the contents of Whistler's book as a ove has been given mainly derived from Moore (1884). B.?Daniel Whistler?The Man Daniel Whistler, one of three sons of William Whistler, was born at Walthamstow, Essex, in 1620. Receiving his early education the Free School at Thame, Oxfordshire, he entered Merton College, Oxford, in January 1639, and graduated B.A. in 1642. n t of the same August year he the of medicine at e> en, and began study graduated there on 19th October 1645, having in the meantime returned to Oxford for a short time to take his M.A. on 8th e ruary 1644. to , Returning England, Whistler was M.D. at x 01 on 20th incorporated May 1647, and on 13th June 1648 was elected Pro essor o at Geometry Gresham College, and at the same time was appointe Linacre reader at Oxford. He resigned his professorship on is marriage in 1656. The Royal of Physicians of London elected him a College Fellow in 1649. Whistler had some of naval in w en he experience surgery 1652 took of charge wounded seamen, wrhile in October 16531 panied Bulstrode Whitelocke in the latter's embassy to Sweden.acco1^1 In this post he appears more the diplomat and than t and politician physician, his merits as such were Cromwell evidently appreciated by with whom Whistler Back home corresponded. in London Whistler resumed his and soon by July i654> practice, became an active Fellow of the Royal College of Physicians. He was Harveian Orator in 1659 ; Censor twelve times between 328 H. P. TAIT 1657 and 1680, and was one of the Censors in 1663 when Sydenham was admitted a Licentiate of the College (Latham, 1648) ; Registrar in 1674-1682 ; Treasurer in 1682, and finally succeeded Dr Thomas Coxe as President in 1683. This position he held till his death on nth May 1684. Dr Coxe, whom he succeeded as President of the College, was the same Dr Coxe who persuaded Sydenham to take and who was of his up the study of medicine, deprived presidential " chair because he was whiggishly inclined." Whistler was a man of considerable versatility as his medical, mathematical, political and social activities indicate. He was a man of culture and wit, and his variety of scientific interests obtained for him election as Fellow of the Royal Society in 1663. He spoke French and Latin well, and could turn out creditable Latin verse when the situation called for such. Socially, Whistler enjoyed wide popularity and was a good mixer. Even as a student he apparently had the time to devote to social activities, for he was the recipient of a volume of Latin verse compiled by his fellow-classmates on the occasion of his graduation. In London, he was a frequenter of taverns, especially the Crown Tavern. He was well known to the two eminent diarists of the period. Evelyn supped often with Whistler and other eminent figures of the time, as he records in his diary on 29th February 1675-76, and 29th January " 1682-83.