_WILLIAMS, STOKES, AND DISEASES OF THE CHEST._
Although this country has not enjoyed the distinction of introducing
that invaluable instrument, the stethoscope, to medical science,
great interest naturally attaches to those who first used the
stethoscope in this country. And among these the name of Charles John
Blasius Williams is prominent.
CHARLES WILLIAMS, the son of a clergyman of a Cardiganshire family,
was born early in the present century at Heytesbury in Wiltshire,
where his father was perpetual curate, and custos of the Hungerford
almshouse, in which he resided. He was educated at home by his
father. His early liking for natural science and medicine may be
considered to have come through his mother, who was the daughter of
a surgeon, also named Williams, at Chepstow, and had been educated
by Hannah More’s sisters, and received instruction in reading from
Hannah More herself. Before the age of fourteen, having access to
some good books on natural philosophy, he had made for himself two
electrifying machines, a battery of Leyden jars, a voltaic pile, and
several little telescopes, microscopes, kaleidoscopes, and æolian
harps. Thomson’s Chemistry enabled him to carry on extended chemical
experiments, and to start well at Edinburgh subsequently.
Astronomy, a lifelong hobby, was cultivated in the family after
the reading of Chalmers’s astronomical discourses; they bought a
telescope and did some really good observing. Active games were not
lost sight of: and the young Charles excelled all his neighhours in
leaping and running. Stilt-walking was a favourite pursuit; and the
youth once made a pair of stilts with a footing twelve feet from the
ground, mounted on which he could walk well, and look into the upper
windows of the house. Natural history tastes were further carried out
in a somewhat unusual direction. Poultry and all kinds of domestic
animals were studied so minutely, and their cries imitated so
closely, that Charles could influence their behaviour towards himself
just as if he had been one of themselves.[13]
In the autumn of 1820 Charles Williams entered at Edinburgh
University, attending Hope’s interesting lectures on Chemistry and
the dry prelections of Monro tertius on Anatomy, alternated with
Barclay’s extra-academical class. Later he diligently attended W.
P. Alison’s courses of lectures, and had much personal instruction
from him. He had not proceeded far in his medical studies before he
became absorbed in chemical physiology, and especially in relation
to respiration and animal heat. Carefully studying all the most
recent chemical discoveries, he made new experiments showing that the
change of colour between venous and arterial blood could take place
when the blood was enclosed in an animal membrane out of the body,
and surrounded by atmospheric air. Thus in 1823 he anticipated what
Professor Graham so largely developed in relation to the general
permeability of animal membranes. He further discussed the origin
of animal heat, and suggested various developments of the theory of
combustion. The paper, later amplified into a thesis for graduation
in 1824, attracted Alison’s high commendation, although Hope had
returned the paper with the remark that the subject was quite proper
for a young gentleman’s thesis, but that he declined to enter into
the subject.
In 1824-5 the young doctor heard Charles Bell’s lectures on the
Nervous System at the London College of Surgeons, and attended the
surgical practice of several of the London hospitals. At midsummer
1825 he went to Paris, and in addition to French literature studied
painting, becoming a good amateur landscape-painter both in
water-colours and oils. In the winter he attended Majendie’s lectures
on Physiology and the practice of Dupuytren, Laennec, and many
others. But Laennec, the great auscultator, then in his last year
of life, gained his most ardent devotion. It was surprising, says
Dr. Williams, how little he was valued by French students. Those who
attended his clinique were chiefly foreigners. M. G. Andral’s _post
mortem_ examinations also he found invaluable.
The chief discoveries relating to auscultation were undoubtedly
Laennec’s; yet his knowledge of acoustics was by no means profound,
and he was often not successful in explaining rationally the sounds
that he heard in the chest. Dr. Williams soon started in the path
of applying acoustic laws in this field, and in 1828 he produced
his valuable “Rational Exposition of the Physical Signs of Diseases
of the Chest,” suggesting various improvements in the construction
and use of stethoscopes. Returning to London, Dr. Williams derived
great benefits through an introduction to Dr. (afterwards Sir James)
Clark, so long attached as physician to the Queen, and from the
family acquaintance with Lord Heytesbury. His work above mentioned
was favourably reviewed, and soon made its way; and many of his
explanations are accepted to the present day. After various travels
with patients, he settled in Half Moon Street, Piccadilly, in 1830,
having married his cousin, Miss Harriett Jenkins, of Chepstow.
Becoming a member of the Royal Institution, Dr. Williams was
introduced to Faraday, and was soon engaged to write for the
“Cyclopædia of Practical Medicine,” to which he contributed numerous
valuable articles on auscultation and diseases of the chest. In
these articles he recommended strongly the cure of catarrh by the
heroic process of reducing the supply of fluid. The remedial uses of
counter-irritation were carefully expounded: and dyspnœa, difficult
or distressed breathing, was clearly described.
In 1833, while practice grew but slowly, the second edition of the
Rational Exposition was brought out, containing an enlarged section
on the sounds of the heart in health and disease. For some years Dr.
Williams had considered the questions involved, and by experimental
inquiries in 1835 he established that several causes to which they
had hitherto been ascribed could not be the cause of the sounds of
the heart, and that the first sound was produced by the muscular
contraction of the ventricles, and the second by the reaction of the
arterial blood tightening the semilunar valves. His anticipation
by Rouanet in 1832 in the latter point has, however, been more
recently made evident. A third edition of his book, now of increased
importance, was published in 1835, under the title of “The Pathology
and Diagnosis of Diseases of the Chest, illustrated especially by a
Rational Exposition of their Physical Signs.” It was reprinted in
America, and translated into German and Swedish. The same year he was
elected F.R.S.
In 1836 Dr. Williams was asked to give lectures on Diseases of the
Chest at the Anatomical School in Kinnerton Street, connected with
St. George’s Hospital. In 1836-7 he was president of the Harveian
and the Westminster Medical Societies. In the summer of 1837 he
worked to prepare for the second Report of the British Association
Committee on the sounds of the Heart, in which were brought forward
important experimental results in regard to morbid murmurs associated
therewith. In 1835 he had shown that the true ground of distinction
between different forms of disease of the heart’s valves lay in the
different direction in which the sonorous currents spread the sounds,
and imparted them to the chest walls. Thus he first established the
distinction between basic and apex murmurs, developing his views more
fully in 1836-7-8.
In 1839 Dr. Williams was elected Professor of Medicine to University
College, and physician to its hospital on Elliotson’s retirement.
Work now crowded upon him; in the first winter session he gave 150
lectures and examinations in six months, visited the hospital almost
every day, and gave a weekly clinical lecture. Up to this period
_post mortem_ examinations at the hospital had been made in a mere
open shed, with a wooden shelf, scarcely screened, and without a
table or a supply of water. Dr. Williams himself planned a proper
_post mortem_ theatre; and with the plan he offered £50 towards the
cost,—a munificent mode of action which speedily secured the building
of the required theatre. Dr. Williams’s practical teaching and
luminous lectures caused the Medical School to increase still more
rapidly. He had a class of over two hundred. In 1840 an experimental
research in which Dr. Williams was assisted by Prof. Sharpey proved
the muscular contractility of the bronchial tubes, and confirmed the
great influence of belladonna and stramonium as remedies in asthma,
in suspending this contractility.
The winter of 1840-1 was occupied largely with original experiments
on congestion, determination of blood, and inflammation, which Dr.
Williams treated of in the Gulstonian Lectures at the College of
Physicians in 1841. His results and views were, as acknowledged by
eminent men recently, twenty-five years in advance of his time. Both
Virchow and Burdon-Sanderson have acknowledged their great value. Dr.
Williams claims that he first pointed to enlargement of the arteries
leading to a part as the direct physical cause of determination
of blood to that part. “When the web of a frog’s foot is gently
irritated by an aromatic water, the arteries may be seen through
the microscope to become enlarged, and to supply a fuller and more
impulsive flow of blood to the capillaries and veins, which then all
become enlarged too: the whole vascular plexus, including vessels
which before scarcely admitted red corpuscles, then becomes the seat
of a largely increased current” (_London Medical Gazette_, July 1841).
The year 1841 was marked by the first public steps taken to
establish the Hospital for Consumption and Diseases of the Chest,
which originated with Mr. (afterwards Sir) Philip Rose. A clerk in
his firm suffering consumption found no hospital willing to admit
him, on the plea of the lingering and incurable nature of the
disease. This started the idea of a special hospital, which Dr.
Williams cordially supported, and to which he became consulting
physician. The history and great success of the Brompton Hospital
cannot be followed here; in 1882 it had 331 beds. The great Virchow,
when he visited it in 1881, said, “Here _everything_ is done for the
sick.”
In 1843 Dr. Williams published the “Principles of Medicine,” a work
in which physiology and pathology were largely employed to form a
basis for scientific medicine. It was received with high approval,
and became a standard work in America. New editions appeared in 1848
and in 1856. Sir James Paget and Sir James Simpson among others have
given it the stamp of their marked approbation. The _Lancet_ gave it
almost unqualified praise. In 1846 the Pathological Society of London
was established, and Dr. Williams was chosen its first president.
Its objects were the exhibition, description, and classification
of morbid specimens, and the promotion of pathological research by
systematic observation and experiments. In his opening address, Dr.
Williams answered the sceptical question, “What is the use of opening
bodies? We never find what we expected:” by describing a _post
mortem_ examination of a remarkable case of pulmonary disease. The
examination had been concluded before Dr. Williams arrived, and he
was told that there was enlargement of the heart, which the physician
in charge expected, and was satisfied. Dr. Williams insisted
on careful inspection of the lungs, which disclosed extensive
consolidation, and in addition an unexpected general dilatation of
the bronchial tubes. This was the case in which he first discovered
the connection between that change and pleuro-pneumonia. The very
appropriate motto of the Society, “Nec silet mors,” was suggested by
Dr. Williams.
At the end of the winter session of 1849 Dr. Williams resigned his
professorship and physiciancy, his health having severely suffered
from overwork, and private practice increasing rapidly. He removed
to Upper Brook Street, and here continued for twenty-four years in
full practice. In January 1849 Dr. Williams published his first
account in the _London Journal of Medicine_, on Cod-Liver Oil in
Pulmonary Consumption. He had been studying its application for
three years, but of course the priority in recommending it belongs
to Dr. Hughes Bennett. It was only in 1846, when a purified oil had
been prepared from the fresh livers of the fish, that Dr. Williams
found patients willing to take the oil, and in 1848 he wrote that
he had prescribed the oil in 400 cases of tubercular disease of the
lungs, and in 206 out of 234 recorded cases its use was followed by
marked improvement. The administration of cod-liver oil is such a
commonplace of the present day that it can scarcely be realised that
it is a novelty almost exclusively belonging to the present half of
the nineteenth century. And to Dr. Williams very much of the credit,
and of the proof of its efficacy, is due. A lady first visited on
September 3, 1847, appeared at the verge of death. Cod-liver oil
restored her in a few weeks, and she lived many years after. This was
a sample of the experience which, after many years’ testing, led Dr.
Williams to say, in the great work on pulmonary consumption published
by himself and his son, Dr. C. T. Williams, in 1871, that the average
duration of life in phthisis had been at least quadrupled. Of 1000
cases tabulated, 802 were still living at the last report, and many
were expected to live for years.
The New Sydenham Society, started in 1858, also found an apt first
president in Dr. Williams. Its usefulness in improving medical
literature by translations and republications has been and is very
great. The Lumleian Lectures at the College of Physicians followed
in 1862, and were entitled “Successes and Failures in Medicine.”
They were not published till 1871, when they appeared in the
_Medical Times and Gazette_. Great attention was directed in them
to the hopes and prospects of prevention of disease. In 1873 Dr.
Williams was elected to the Presidency of the Royal Medical and
Chirurgical Society, which he held for two years, though suffering
from gradually increasing deafness. In 1874 he was appointed
Physician-Extraordinary to the Queen. In 1875 he retired to Cannes,
where he has since renewed his earlier astronomical studies, and
made some important observations on sun spots. So in scientific
recreations, and in Biblical studies in which he has long been deeply
interested, the veteran physician whom Dr. Quain describes as “the
principal founder of our modern school of pathology,” passes the
closing years of a protracted life.
* * * * *
The Irish Schools of Medicine have had a briefer history than those
of Edinburgh and London, but have produced men whose character and
labours rank among the highest. WILLIAM STOKES, born in July 1804 in
Dublin, was the son of Whitley Stokes, Regius Professor of Medicine
in the University, a man of lofty aims and untiring energy, and
a very successful teacher of medicine. Father and son alike were
students of the Edinburgh Medical School; but the son owed much
to personal companionship with his father. After a few months at
Glasgow, young Stokes entered at Edinburgh early in 1823, and soon
came in contact with Dr. Alison, who exercised a profound influence
upon him; “the best man I ever knew,” he declared. Such striking
progress did he make, that before he left Edinburgh, in 1825, he had
written and published a little book on “The Use of the Stethoscope,”
which he was fortunate enough to sell for £70.
On settling in Dublin, young though he was, Stokes was elected
Physician to the Meath Hospital, in succession to his father.
His colleague, Graves, one of the most remarkable men Dublin had
produced, exercised a striking influence over him. At twenty-two
Stokes was already lecturing and giving clinical instruction to a
crowd of pupils. The time was one of acute distress and poverty in
Ireland; fever raged in Dublin, owing to the distress caused by the
failure of the potato crop in the summer of 1826. The Meath Hospital
was crowded, and the young physician was taxed to the utmost, and his
benevolent charity became fixed as a second nature.
During these years of activity, a powerful special object was
employing his most persistent thought and observation. He was
diligently storing his mind with every fact and inference bearing on
diseases of the lungs. In 1837 his observations were published in the
classic work on “Diseases of the Chest.” It at once placed him, says
Sir Henry Acland in the memoir prefixed to the edition published by
the New Sydenham Society in 1882, in the front rank of observers and
thinkers. His exposition of the use of auscultation in bronchitis and
the affections of the chest was most valuable.
In 1842 Stokes became Regius Professor of Physic in Dublin
University, in succession to his father. From this time, though he
contributed occasional papers, lectures, and cases of value to the
_Dublin Journal of Medical Science_, and to the medical societies,
he published no book till 1854, when a valuable treatise on
Diseases of the Heart confirmed his reputation. In this he paid
great attention to functional disturbances of the heart, where
no organic disease was present. He says with great modesty, “the
diagnosis of the combinations of diseases, even in so small an
organ as the heart, is still to be worked out.... As the student
fresh from the schools, and proud of his supposed superiority in
the refinements of diagnosis, advances into the stern realities of
practice, he will be taught greater modesty, and a more wholesome
caution. He will find, especially in chronic disease, that important
changes may exist without corresponding physical signs—that as
disease advances its original special evidences may disappear—that
the signs of a recent and trivial affection at one portion of the
heart may altogether obscure, or prevent, those of a disease longer
in standing and much more important—that functional alteration may
not only cause the signs of organic lesion to vary infinitely, but
even to wholly disappear—that the signs on which he has formed his
opinion to-day may be wanting to-morrow; and, lastly, that to settle
the simple question between the existence of functional and that of
organic disease, will occasionally baffle the powers of even the most
enlightened and experienced physicians.”
This treatise is acknowledged to be one of the most acute, graphic,
and complete accounts of the clinical aspects of heart disease.
In 1854 also he published a series of lectures on Fever in the
_Medical Times and Gazette_, which were collected into a volume, with
additions in 1874. Here he showed himself as still sceptical of the
advances made by Jenner, Murchison, and others. As he wrote in one of
the lectures, “there is nothing more difficult than for a man who has
been educated in a particular doctrine to free himself from it, even
though he has found it to be wrong,” and he could never free himself
from Alison’s strong belief that fevers were essentially alike.
Very early in his career Stokes was overwhelmed with private
practice. On more than one occasion he spoke and wrote strongly
regarding the exertions and the mortality of Irish doctors in
combating fevers and cholera, while receiving the merest pittance
from Government for their services. His feelings as to everything
relating to the welfare of the profession and the general culture of
the student were actively displayed. “Let us emancipate the student,”
he said, “and give him time and opportunity for the cultivation of
his mind, so that in his pupilage he shall not be a puppet in the
hands of others, but rather a self-relying and reflecting being. Let
us ever foster the general education in preference to the special
training, not ignoring the latter, but seeing that it be not thrust
upon a mind uncultivated or degraded.”
Prevention of disease, too, engaged Stokes’s earnest attention,
before sanitary science had come into fashion. “A time may come,”
he said, in closing one of his addresses, “when the conqueror of
disease will be more honoured than the victor in a hundred fights.”
Sir Henry Acland says of Stokes: “The study of man was with him an
instinct, both on the material and on the intellectual side. On
the material side; for he was a physiognomist, a great judge of
character, and had a keen perception of all physical characteristics,
qualities which he obtained by intense observation of men in
disease, of men in health, and of persons in every class of society
and every kind of occupation. On the intellectual side; for the
phenomena of man’s external nature were to him only expressions of
the mind working within,—mind the result of inheritance—mind formed
by itself—mind the result of circumstance. The second thing to be
remarked was his intense interest in every form of human character,
in persons of every age, occupation, and condition. He had that which
many accomplished persons have not, the keenest sense of humour,
which sparkled up in a way quite indescribable. He combined with
real delight in all intellectual development the most tender human
interest.”
Stokes was passionately fond both of natural scenery and of landscape
art; and he enjoyed the companionship and friendship of the best
artists, and at the same time appreciated greatly the interests of
humble life and the racy humour of the Irish peasantry. He wrote
some charming descriptions of scenery, and was well acquainted with
various schools of art. The antiquities and history of Ireland too,
found in him an accomplished and appreciative student; and it was
felt to be an appropriate tribute to his variety of taste as well
as his professional skill when he was chosen President of the Royal
Irish Academy in 1874.
One valuable habit Dr. Stokes ascribed to his father. “My father left
me but one legacy, the blessed gift of rising early.” This often
meant getting up between four and five, when he would study and write
till eight. During a long day’s practice he was always exercising the
most genial influence, whether over refractory students or harassed
patients. At the close of the day his hospitality was as attractive
as his professional manner during the earlier hours.
In 1870 Mrs. Stokes died, and from this blow her husband never fully
recovered. In 1876 he found himself compelled to withdraw from his
many public posts, and retire to his cottage at Carigbraig, where to
the last the flights of birds which he had encouraged and trained
came to seek their food at his hands. He died on January 6, 1878.
FOOTNOTES:
[13] A most entertaining account of his encounters with a game-cock
is given in Dr. Williams’s “Memoirs of Life and Work,” 1885, from
which most of these particulars are derived.