Review Thomas Wakley (1795–1862): a biographical sketch David Sharp Lancet 2012; 379: 1914–21 Thomas Wakley—founding editor of The Lancet, member of Parliament, coroner and, for 12 years, all three Published Online simultaneously—died 150 years ago. His fullest biography is more than a century old, but still provides a good account May 16, 2012 of the struggles and achievements of this extraordinary yet at times rather diffi cult and overstretched man. DOI:10.1016/S0140- Nonetheless, there are gaps, and this anniversary provides a chance to fi ll in a few of them. 6736(12)60526-1 2 Iron Mills, Minchinhampton, UK (D Sharp MA) Introduction The man from Devon Correspondence to: “Reformer indeed! Thomas Wakley...was more than a At Land Farm (fi gure 1) in the east Devon parish of Mr David Sharp, 2 Iron Mills, reformer, he was a revolutionary, and who has heard of Membury towards the end of the 18th century, Henry and Minchinhampton, The Lancet except for you medical people!” Mary Wakley were raising a large family, of whom Gloucestershire GL6 9AL, UK Thomas was the youngest. Wakley genealogy is [email protected] Vic Feather, then Trades Union Congress assistant general secretary (1960–69), in conversation with Wakley biographer complicated by Wakeleys and Wakelys and the pro- See Online for appendix Dr Charles W Brook nunciation remains controversial (appendix). Henry was a successful farmer, a vigorous horseman, a defender of Thomas Wakley, founder of The Lancet, died on May 16, the Corn Laws, a local expert on land enclosure, and a 1862. The journal has often been asked for his papers, but Tory—a trait not passed on to his youngest child. In later they are long gone. Thus, Samuel Squire Sprigge’s life he declared himself a gentleman, but he was not well 500 page biography1 from 1897 has to be the starting point educated; “X The mark of Henry Wakley” certifi ed his for any appraisal. In inviting Sprigge to write the biography, marriage in 1772. He died aged 92. Wakley’s eldest son and grandson wanted to avoid their We do not know why young Thomas chose to study forebear’s story being told “through the imperfect lens of medicine. He served apprenticeships under three men. family aff ection”,1 but Sprigge’s own lens is at times rose Thomas Incledon, a druggist in Taunton, might have tinted. There are several omissions—for example, Wakley’s been the fi rst; Wakley’s brother-in-law Richard Phelps, wife and daughter are not named; his huge property a surgeon–apothecary whom Wakley joined in investment, his being called on to fi ght a duel, and his Beaminster in 1812 was the second; and a surgeon challenge to the medical care of King George IV are not called Coulson from a medical family in Henley on mentioned; and his non-Lancet writing is incompletely Thames was the third (a William Coulson was known to covered. However, Wakley the combative reformer inside have been “associated with The Lancet in its infancy”).7 and outside medicine is well described by Sprigge and In 1815, Wakley moved to London and in 1817, he others,1–6 and his many achievements can surely withstand qualifi ed as a member of the Royal College of Surgeons a critical inspection of his methods. of England (MRCS) (fi gure 2). Wakley left London for some months1 but, unable to fi nd a practice near Membury, he returned to London, to rooms in Gerard’s Inn, where he saw patients. Aged 24, he married 21-year-old Elizabeth Goodchild, who was the youngest daughter of a wealthy businessman and hospital governor. Established by his father-in-law-to-be in a fashionable London practice, Wakley was set for a prosperous, orthodox career. Had that been fulfi lled, he would have disappeared from history. Contemporaneous impressions We have a good idea of what Thomas Wakley looked like (appendix). The only photograph (fi gure 3) was taken in the year he died but the young Wakley was tall, well built, clean shaven, and athletic. He walked between Devon and his London lodgings, which was a journey of about 150 miles. His allowance of £80 a year left little money for strong drink or, in Sprigge’s deli cate phrase, “the Fleet Street amour”.1 Clean-living, non-smoking, and P Sharp perhaps slightly puritanical, young Wakley enjoyed Figure 1: Land Farm, Wakley’s birthplace boxing, billiards, quoits, and chess in his spare time. The house began as a medieval longhouse and was extended in 1629, and again in the 19th century. Most of the land was sold 40 years ago. Situated hygienically over a still-running small stream, is a three-seater water closet, One contemporaneous description gives Wakley a now used to store garden furniture. Could it have been young Thomas Wakley’s “necessary house”? “portly, bulky frame...and a rolling, almost rollicking gait, 1914 www.thelancet.com Vol 379 May 19, 2012 Review his broad, fair face inspired with good-humor, and his massive forehead set off by light, almost fl axen hair, fl owing in wavy freedom backward around his head”.8 He looked like a provincial, the account continues, a touch snootily, “and has also the accent of one”. A less kind account describes him as “a tall stout man, with fair hair and a rather fl orid complexion...a round full voice and somewhat low-lived swaggering air, a suspicious cast of countenance”;9 the Illustrated London News and Punch were also rude. This description does not sound like Wakley the battle-hardened campaigner, but he made enemies. However, another observer described him, more accurately I believe, as a “zealous advocate of the College of Surgeons of Royal England working classes” and an “honest denouncer of invidious Figure 2: Royal College of Surgeons in 1817, the year Wakley qualifi ed distinctions betwixt the rich and the poor”,10 distinctions that Thomas Wakley encountered in all three of his roles and in all walks of life, including his own profession with its complacent, self-perpetuating oligarchies and its downtrodden ordinary practitioners. The Lancet: what’s in a name? Around 1820, high taxation in the aftermath of the Napoleonic wars, the price of corn, a corrupt electoral system, and repressive legislation were fuelling discontent, and it was a betrayed plot to assassinate the Cabinet (the Cato Street conspiracy) (fi gure 4) that led, indirectly, to The Lancet being founded. In August, 1820, Wakley was seriously assaulted and his home at 5 Argyll Street was set on fi re. The 15 room house and medical practice was destroyed. In the wake of the arson and a legal battle over the insurance, the Wakleys led a restless existence, eventually settling down in Norfolk Street, Strand—a district not genteel enough for Mrs Wakley, who urged a career switch if need be. Wakley’s decision to abandon clinical practice and to seek, via journalism, change in the way medicine was organised and taught does seem sudden, although he had described the MRCS examination as a farce. If, as Sprigge claims, “[t]he soul of the reformer had always been in Wakley”,1 the young surgeon had been keeping quiet about it. Most 18th and early 19th century medical journals were short lived.11 An exception was the New England Journal of Medicine, which was founded in the USA in 1812, with “a heritage of British standards and traditions”,12 and one historian has suggested that the physician Walter Channing, who was associated with the Boston journal, was the fi rst to encourage Wakley into journalism. The late Mary (Betty) Bostetter, who never completed her biography of Wakley, described a meeting between Channing and Wakley, presumably in 1822 or 1823.13 Her sources are no longer accessible but, by 1822, Channing Figure 3: Photograph of Thomas Wakley was well established in Boston and his pregnant wife was This photograph seems to have been taken in a studio on Madeira (where Wakley died) in 1862, because the dying of tuberculosis. Could he have been in London bound volume of the journal used as a studio prop shows the full years of his editorship of The Lancet. around this time? Furthermore, in the 1850s Channing wrote that he had not, for over four decades, had a long is on fi rm ground. His Political Register supported Wakley, vacation.14 If the infl uence of Channing remains to be and the respect was mutual; Thomas Wakley was among resolved, that of the journalist William Cobbett (appendix) the leading mourners at Cobbett’s funeral in 1835. Besides www.thelancet.com Vol 379 May 19, 2012 1915 Review Medical editor (1823–62) The corruption Wakley wished to lance permeated London’s hospitals and medical teaching. Wisely, The Lancet did not have bylines, and the identity of the editor was a secret for a while. One waspish contributor (known as Erinensis, probably Peter Hennis Green)7 preserved his anonymity by being paid in cash, which was handed over in a coff ee house. The openly political topics in early issues sound like Cobbett but he never wrote for the journal.7 He did attend editorial meetings, along with William Lawrence, James Wardrop, and—a wise if not wholly successful precaution, this one—a lawyer. Important Lancet campaigns included reform of the Royal College of Surgeons of England (the apothecaries and physicians did not escape); exposition of mishaps at London teaching hospitals (an early example of medical audit?); freedom to publish lectures, for which hospital staff were earning huge sums; the proper supply of bodies for dissection; the establishment of a register of medical practitioners; raising the standard of coroners’ inquiries; tackling the adulteration of food; and exposition of fraudulent medical practices and the serious failings of the Poor Law.1–6 Illumination, via the reporting of advances in clinical practice, came in time.5 From the start, Wakley wanted to use plain English.