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Joural of the Royal Society of Medicine Volume 83 August 1990

A tale of two paintings and the London medical scene of the late 18th century

John P Griffin FRCP FRCPath Association of the British Pharmaceutical Industry, 12 Whitehall, London SWIA 2DY Keywords: Hawes; Lettsom; Cogan; James; Goldsmith

The object of this article is to document the history of a pair of pictures of considerable medical interest which hung in my office for 7 years and to use them to illustrate some of the events that were occurring on the contemporary medical scene of the late 18th century in London.

Description of the paintings The paintings are of identical dimensions with a canvas size of 50x40 in (127x 102 cm). Both pictures are in their original gilt frames, each caurying the original superscription. One superscrption states: 'Presented by the Royal Humane Society to -BenjHawes 1787'. The other superscription has been reduced in size and the first line stating. 'Presented by the . . .' has been cut-off. Mr R T Hawes (personal communication) had pictures of the paintings before they were restored with a French inscription, it may be that these were the original inscriptions, since there is some confusion as to the original date of the

paintings. The first picture shows an areadian river scene with a flat-bottomed punt style boat containing three nm. One of the men is holding a punt pole to steady the vessel, the other two are attempting to lift the body from the water, aided by a fourth man who has got into the river and is supportng the body. On the river bank is a well-dressed person with grey hair, blue coat and red waistcoat kneeling to lift the body from the river. A second group in the picture is composed of a young man in a long knee-length coat in brown who is supporting a woman in a green dress who has fainted. Two small children are clutching at her skirts.

Figure

1. The young

man

restored to life: the

rescue

lool.

4

I

.1

Figure 2. The young man restored to life: resuscitation The second picture shows an interior scene in a country cottage with a young man lying part supported on a wooden bed. The door of the room opens to a rural sceike. The young man on the bed can be clearly recognized as the unfortunate man being lifted from the river in the earlier scene. The young man has made sufficient recovery, having nearly drowned, to be sitting up supported around the shoulders by a bewigged middle-aged man expensively dressed in black silk trousers and waistcoat and brown three-quar length coat. His tricorner hat and a walking stick with silver head are neatly placed on the floor. This man has been identified as^Dr William Hawes. On the other side of the bed are two of the three men who were in the punt in the first picture. In the doorway of the cottage stands the woman in the green dress with her two children, clearly relieved at the recovery of the young man. A very tall distinguished-looking gentleman in white periwig and grey attire broken only by laced white collar and cuffs is standing with arm outstretched presenting the now recovering young man to the woman in green. He is clearly very self-satisfied with the patient's recovery. This gentleman has been identified as Dr John

Lettsom, founder of the London Medical Society. From a medical point of view, the instruments of the man's recovery are indicated: at the foot of the bed is the warming pan to correct any hypothermia, brandy bottles, and two clear glass medicine bottles with spoon. The observer ofthe scene is left with some doubt as 0141-0768/90/ 08052004402.00/0 to which contributed most to the young man's resusci- © 1990 tation, the prayer of the clergyman, the skill of The Royal Dr Lettsom and Dr Hawes, the efficacy ofthe brandy Society of and medicines or the correction of the hypothermia. Medicine

Journal of the Royal Society of Medicine Volume 83 August 1990

The recovering young man has a profound reactive hyperaemia of the chest wall and it would be interesting to know whether this depicts recovery from hypothermia or whether it is the consequence of vigorous pounding of his chest during resuscitation.

The artist The pictures are unsigned but are identified by the Royal Humane Society who commissioned them as having been painted by Robert Smirkel. Smirke was born in Wigton near Carlisle in 1752 and died in London on 5 May 1845. He was a painter and illustrator. He was a pupil at the Royal Academy but had a difficult career and earned a living painting coats of arms on carriages. He exhibited paintings in London regularly from 1775 to 1834 at the Society ofArtists and the Royal Academy. He became an ARA in 1791 and an Academician in 1793. His work covers subjects from the Bible, English history, Shakespeare's works, 'Don Quixote' and 'Thousand and One Nights'. Smirke was commissioned to paint this pair of pictures for the Royal Humane Society but it is not known whether the events depicted cover a specific incident involving Dr Hawes or whether they are symbolic of his life-long involvement with resuscitation of victims of drowning. The two pictures were copied and engravings made in 1787 by Robert Pollard which leads one to the conclusion that the paintings had been made earlier than the 1787 date on the superscription. Copies of the Pollard engravings can be seen at the London Medical Society, Royal -Bath Hospital, Bath and at the headquarters of the Royal Humane Society at Brettenham House, Lancaster Place, London. The pair of engraviing by Pollard are entitled 'The Young Man Restored to Life'.

History of the pictures The pictures were sold by the Hawes family by auction (Lot 123) at Christie, Mason and Woods Ltd at Spencer House, St James Street on 25 February 1949 for £30. They were re-auctioned at Christies in 1976 and sold for just under £4000. An application for export was refused and they were acquired by the Department ofthe Environment for £8000 to be hung in a public building. They hung in my office from July 1977 to July 1984. The origins of the Royal Humane Sociey It seems that the art of resuscitating the drowned originated in Britain. In 1745 Dr William Tossach resuscitated a man, apparently dead, by distending his lungs with air. The physician, John Fothergill, communicated this case to the Royal Society and concluded that it was possible to save life in this way. The English medical world was not persuaded and persisted in the belief that life ended when breathing ceased. Dr Fothergill was described by Fanny Burney2 as follows: 'His conversation consists of sentences spoken with the utmost solemnity, conciseness and importance. He is an upright, stiff, formal looking old man. He enters the room and makes his address with his hat always on, and lest that mark on his sect pass unnoticed (for he was a Quaker), the hat he wears is of the most enormous size I ever beheld'. Later she writes of him: 'He has been my very

good friend.'

Fothergill3 was a close personal friend of John Howard, the prison reformer whose work he admired and supported. Fothergill was also the mentor to John Coakley Lettsom who arrived in London in 1760 having been earlier apprenticed to the apothecary, Abraham Sutcliffe of Seattle, Yorkshire, from the age of 16 years. Lettsom took his MD from Leyden in 1769 and for the following 11 years was alnost an atant to Fothergill in his practice. In later years Lettsom wrote: 'As a -medical man my character was solely reflected from the patronage of Dr Fothergill ... my medical creation was his.' Dr Fothergill died in 1781. On the continent Fothergill's paper attracted attention and in 1767 a 'Society for the recovery of the apparently drowned' was formed in Amsterdam. In 1773 Thomas Cogan translated the Amsterdam Society's transactions into English. Dr Thomas Cogan was born in Rowell, Northamptonshire, in 1736. He was the son of an apothecary, and was descended from an old family of dissenters, and after studying for the ministry, he preached in Holland and at Southampton. Later he retumed to Holland and became one ofthe officiating ministers at the English church at Amsterdam, Leyden and-Rotterdam. He later returned to practise medicine in London. William Hawes4 at the age of 37 years read Dr Cogan's translation of the transactions of the Amsterdam Society, at which time he was practising as an apothecary at Palsgrave Place off the Strand, London. He was stimulated by what he read and the following year he tried to carry out the treatment recommended by the Dutch Society, and actually paid people who brought him bodies within any reasonable time after iersion (which were brought ashore from the Thames between Westminster and London Bridges) for resuscitation. Apparently he encountered not only ridicule but opposition on account of these philanthropic efforts. It was stated that even the possibility of resuscitation was denied but Hawes persevered and was suc l in achieving resuscitation in several cases. William Hawes5'6 was born at Islington, London in 1736 (the same year as Thomas Cogan). He was educated by a local master, John Shield, and afterwards went to St Paul's School. He was then apprenticed to Mr Carson, a medical practitioner of Vauxhall and later became assistant to a Mr-Dicks in the Strand and eventually su to his practice. In 1774 William Hawes was ap Aed by D or Coan who objected to William Hawes bearing all the expense of the rewards out of his own pocket and sugges_tedthat they each bring 15 friends to a meeting arranged to be held on 18 April, 1774 at the Chapter Coffee House, St Paul's Churchyard, London, when William Hawes, by then in practice at Thomas Street, and Dr Cogan, would propose the foundation of 'The Institution for affording immediate relief to persons apparently dead from drowning. Amongst those who attended that first meeting were the Lord Mayor of London, Mr Frederick Bull, who agreed to become the Institution's first President; Oliver Goldsmith, the poet; Drs John Coakley Lettsom, William Heberden, and William Bancroft; David Garrick the actor; and Mr BenJamin Hawes. The terms of referenD of the Institution were given on the title page of a 10 page pamphlet 'The Institution for affording immediate relief to persons apparently dead from ning. And also for diffusing

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Journal of the Royal Society of Medicine Volume 83 August 1990

a general knowledge ofthe manner of treating persons in a similar state from various other courses; such as strangulation by the cord; suffocation by noxious vapours etc. According to the plan proposed by Dr Cogan and Mr Hawes, London. Printed by order of the Society in the year 1774'. The Society originally made use of the methods of the Amsterdam Society which consisted of: (i) warmth, (ii) artificial respiration by mouth-to-mouth inflation with compression of the abdomen and chest, (iii) fumigation by the introduction of tobacco smoke into the rectum, (iv) rubbing the body or friction, (v) stimulants, (vi) induction of vomiting. The first report of the Institution was presented with the first four cases of successful resuscitation which occurred on 12 July 1774. Between July and December 1774 eight persons were successfully resuscitated and during 1775 a further 33 persons had been saved out of 67 accidents. The Institution rapidly changed its name to the 'Society for the recovery of persons apparently drowned' and by 1776 had become 'The Humane Society'. In 1777 Dr James Parkinson became one ofthe first recipients of the Society's Silver medal. He is better known for his description of the eponymouslycommemmorated Parkinson's disease. His father, John Parkinson, was medical assistant to the Society for the New River area. By the completion of the Society's report for 1777 (dated 25 August 1778) a total of 167 cases had been treated. In the reports of the Society for 1781-82 it is recorded that a Bible, a book of Common Prayer and a 'religious booke' were to be given to everyone restored from apparent drowning by the Medical assistants. In 1781 William Hawes obtained his MD and from henceforth practised as a physician rather than an apothecary. In 1787 the Humane Society became the 'Royal Humane Society', that is, in the same year that the pictures presented to Benjamin Hawes were painted by Smirke and etchings of them made by Pollard. Drs Hawes, Lettsom and Bancroft were founder members of the London Medical Society which probably accounts for the Pollard prints in this Society's buildings. Heberden had well-known associations with rheumatic diseases and first described the nodules known as Heberden's nodes and frequented the Hot Springs at Bath in a professional capacity, which probably accounts for the Pollard prints in the Royal Bath Hospital. For the first 6 years of the Royal Humane Society's existence from 1774 to 1780 the reports were written by Dr Cogan, but in 1780 Dr Cogan returned to Holland and from 1780 Hawes prepared the reports until his death in 1808, and these reports were then continued by Dr John Coakley Lettsom. Dr William Hawes was Treasurer and Chairman of the Royal Humane Society as well as Registrar from 1796 to 1808. By the time ofthe 1809 report, the Society was able to report on 15 165 apparent deaths with 3213 successful resuscitations. The report of the Royal Humane Society for 1807 announced that Tsar Alexander I of Russia had been awarded the Society's Gold Medal for saving the life of a Polish peasant apparently drowned in the

River Wilna. (A painting commemmorating this event hangs in the Royal Society of Medicine, London.) The recipient of the two paintings by Smirke, Benjamin Hawes, the son of William Hawes, was Chairman from 1820 to 1860, but had been a founder member of the Society and was given a Gold Medal after he had been Chairman for 25 years. Dr William Hawes2 was a man of wide medical interests. He wrote a critique of Rev John Wesley's medical practices of electric shock treatment using a Wimhurst machine and Leyden Jars entitled 'An examination of the Rev John Wesley's Primitive Physic' in 1776 which appeared in its 3rd edition in 1780. Oliver Goldsmith was a fellow member of the Institution later to become the Royal Humane Society and was a patient of Dr Hawes. It appears that Hawes was the subject of a libel that it was he who killed Goldsmith by overdosing him with James' Powder, whereas the contrary was true. Hawes had advised Goldsmith not to take the concoction, but Goldsmith had obtained supplies of this patent anti-fever remedy from a shop run by Mr Newbery which he took after two to three doses of a preparation containing opium which he had obtained earlier from Dr Hawes. During his final illness Goldsmith was also seen by Drs Fordyce and Turton, both of whom seem to have had their advice ignored, since Goldsmith continued to dose himself over a period from 25 March to 4 April with James' Powder. The principle ingredient of Dr James' Powder appears to have been antimony. Goldsmith's final hours seem to have been attended by an apothecary called Charles Maxwell of Fleet Street. Maxwell had been visiting apothecary to the Middlesex Hospital in 1759. Oliver Goldsmith appears to have died after profuse diarrhoea of some 9 days duration in terminal convulsions which is probably consistent with poisoning. James' Powders were invented for the treatment of fevers by Robert James, an apothecary who later became a physician. Dr James was a life long friend of Dr Samuel Johnson, the producer of the first English lexicon. To clear himself of the charge, Dr William Hawes wrote a pamphlet entitled: 'An account of Goldsmith's illness as far as relates to the exhibition of Dr James' Powders (London Medical Society Tracts 1774)4. Dr James' fever powder Dr James' Fever Powder7 was patented by Dr Robert James, a Cambridge graduate, in 1747. There appears to have been some debate as to its composition and an analysis by George Pearson read to the Royal Society on 23 June 1791 entitled 'Experiments and observations to investigate the composition of James' Powder' concluded that it consisted of 'a metallic calx a part at least was antimony, mixed with earthy

matter'. The general consensus of opinion was that it was produced by 'calcining together bone-ashes and antimony in certain proportions and afterwards exposing the mixture to white heat' a compound was formed consisting of antimony, calx and phosphorated lime, and possessed the same kind of properties as James' powder. In 1760 Fleming commented on the damage of antimony if improperly used while being generally favourable to the powder, stating it as a dangerous medicine and not a cure all for every fever. In 1774 John Miller in his 'Observations on Antimony'

Journal of the Royal Society of Medicine Volume 83 August 1990

concluded that antimony therapy was difficult in skilled hands and objected to its use by those without medical skill. Perhaps a forerunner of a demand for a Prescription Only Status for certain medicinal products. The use of James' powder was popularized by the wide advertising of the product by a London Bookseller, John Newbery, who James had appointed his sole agent. The reputation of James' powder was such that it was tried on George HI in 1788 in his attack of his much debated illness and was effective in reducing the fever but not the delirium. Newbery collaborated with Oliver Goldsmith in writing 'Little Goodie Two Shoes' in which the heroine's father 'died meserably because he was seized of "a violent fever in a place where Dr James' Powder was not to be had".' In 1787 The London Pharmacopoeia introduced a standardized powder 'part sulphurated antimony' and 'part hartshorn', under the title 'Pulvis antimonalis'. There was also rumour that the original powder contained mercury and some play was made of this in claims that the 'patent medicine' differed from the 'official monograph' in the London Pharmacopoeia. The preparation remained widely used in the treatment of fevers throughout the 18th and 19th centuries and was a component of many domestic medicine chests including Queen Victoria's.

Finale In 1791 Dr John Coakley Lettsom and a group of physicians, Dr Hawes among them, founded the Sea

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Bathing Hospital in Margate. Also in 1791 Dr Hawes moved to Spital Square and in 1793 commenced a charitable work to alleviate the distress amongst the Spitalfields weavers. Dr Hawes died in 1808 and his friend Dr Lettsom in 1815. Acknowledgments: The author thanks Major A J Dickinson for his help, and Mr R T Hawes Esq, TD for discussion on the paintings' history. References 1 Bishop PJ. A short history ofthe Royal Humane Society. To mark its 200th Anniversary. London: Royal Humane Society, 1974 2 Booth CC. The Fothergillian Medals of the Medical Society of London. J R Coll Physicians Lond 1981; 15:254-8 3 Fanny Burney's Diary. London: Folio Society, 1961 4 Crellin JK. Dr James' Fever Powder. Trans Br Soc History Pharmacy 1974;1:136-43 5 Stephen L, Lee S, eds. The dictionary of national biography, vol 9. Oxfordc Oxford University Press, 1917:190 6 Dickinson AJ. Secretary of the Royal Humane Society, personal communication re. Robert Smirke. 7 Whittet TD. The Apothecary William Hawes, and two notable bicentenaries. Pharmaceutical J 1974;213:86-7

(Accepted 16 October 1989)

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A tale of two paintings and the London medical scene of the late 18th century.

520 Joural of the Royal Society of Medicine Volume 83 August 1990 A tale of two paintings and the London medical scene of the late 18th century Joh...
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