CHAPTER XXI

.

_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.

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