BRITISH MEDICAL JOURNAL
16 DECEMBER 1978
Charles White of Manchester: the 250th anniversary of his birth G BEHR British Medical3Journal, 1978, 2, 1699-1700
The year 1978 is the 250th anniversary of the birth of Charles White, the founder of the Manchester Royal Infirmary and St Mary's Hospital, the originator of lectures to medical students in Manchester, and the pioneer of aseptic midwifery 75 years before Semmelweiss.
Innovating spirit Charles White was born on 4 October 1728, the son of Thomas White who practised as surgeon and man-midwife in Manchester. After an apprenticeship with his father he went to London to study under William Hunter and form a lifelong friendship with his fellow student John Hunter. After a winter in Edinburgh he returned to Manchester to his father's practice. His experience in London and Edinburgh stimulated him to take a leading part in founding the Manchester Infirmary when he was only 24 years old. It was opened on 24 June 1752 in a rented house with accommodation for 12 patients, and was so successful that within three years it moved to a newly built hospital of 40 beds. In 1762 he received the "Grand Diploma" of the Corporation of Surgeons and on the same day was elected a fellow of the Royal Society. His originality and innovating spirit is shown in many of his publications. Of the 19 papers listed by Cullingworth' most include a new concept or method of treatment, and show him as an advocate of conservative surgery. In his first paper he proposed removing the ends of the bone in cases of ununited fracture. He recommended using dried sponge for the arrest of haemorrhage, and was one of the first to remove the head of the humerus for caries of the shoulder instead of removing the whole arm. Despite his large practice he kept his interest in anatomical dissection, which had been stimulated by the Hunters. When in 1783 a college of arts and sciences was started in Manchester, he took charge of the anatomy department and could illustrate his lectures with about 300 preparations from his own collection. These were the first public lectures to medical students delivered in Manchester. Unfortunately this collection, which he presented to the maternity hospital, was destroyed by fire in 1847.
Reforming obstetric practice His most important work was published in 1773: "A treatise on the management of pregnant and
lying-in women, and the
Department of Pathology, Burnley General Hospital, Burnley BB10 2PQ G BEHR, FRCP, FRCPATH, group pathologist
Charles White, FRS, after a portrait by J Allen, engraved by W Ward, 1809.
means of curing, but more especially preventing, the principal disorders to which they are liable." At the time puerperal fever was rampant, especially in lying-in hospitals, which had mortality rates of up to 1 in 25. But he could state in his book: "The practitioner can only judge from the result of general practice; and here for the sake of the most important argument I can use, I am obliged to refer to a fact, which otherwise could scarcely be mentioned without a show of ostentation, which I despise. Out of the whole number of lying-in patients whom I have delivered (and I may safely call it a great one) I have never lost one. . . Some few indeed have had the puerperal fever, but this has evidently arisen from non-observance of the rules above laid down." These rules have been summarised by Adami2 in the following way. (1) That puerperal fever is primarily a filth disease, due to foul surroundings and retention of discharges and the opportunity that this affords for decomposition and putrefaction, conditions that may be prevented by proper treatment and strict cleanliness. (2) That it is not a specific disease, but of the same order as the old hospital and jail fevers, which likewise are brought about by overcrowding, filth, and foul air. (3) That the disease may be carried from one patient to another, whence it is advisable that as soon as the fever seizes a patient in a lying-in ward, she should be moved to another room. (4) That when a case has occurred the room should be disinfected, or, in White's own words: "When a patient is removed to another room the bedding and curtains should be washed, the floors and woodwork should be cleaned with vinegar, and it would still add to the salubrity of the apartment if it was stoved with brimstone."
BRITISH MEDICAL JOURNAL
(5) That the patient should lie with her head and shoulders high and sit up frequently to prevent the lochia from stagnating. In the third edition he adds: "I must not omit to mention in this place the good effects I have experienced from emollient or antiseptic injections into the uterus, by means of a large ivory syringe or an elastic vegetable bottle."
The word antiseptic, derived from the Greek word septikos, rotten or putrid, is used here in the original sense of resisting putrefaction. It was used in this sense in 1752 by J Pringle in his book Observations on Diseases of the Army and by James Lind in 1757 in an essay on preserving the health of seamen in the Royal Navy. The antiseptic used was probably vinegar, the large ivory syringe was almost certainly a clyster or enema syringe,3 and the elastic vegetable bottle was a colpeurynter,4 an inflatable bag used for dilating the vagina or uterus to stop a postpartum haemorrhage. White was clearly aware of the contagiousness of puerperal fever and realised that it could be transmitted from patient to patient and prevented by cleanliness, proper ventilation, and by allowing free drainage of the lochia. He did not implicate doctors and midwives as carriers, but while before White puerperal fever was thought to be epidemic with little hope of prevention, for him the emphasis was all on prophylaxis. Semmelweiss in 18615 mentioned the high standard of obstetrics in Britain, where physicians washed their hands in chlorine water and changed their clothes after attending a woman with puerperal fever. This difference between the continent and Britain is difficult to understand, since White's book was translated into French in the same year and into German two years later. It was reprinted in the United States and run to four editions in England. Its influence in England is undoubted, and Thomas Henry in his eulogy after Charles White's death could say: "The knowledge of Mr White's doctrines was generally diffused. Perhaps indeed few medical books have been productive of more important reform in practice, or of more comfort and safety to the subjects, for whose benefit it was intended."6
16 DECEMBER 1978
journeys on horseback, and of bearing without injury to his health, exposure to the most inclement weather." By contrast, according to Garrison,- Semmelweiss's "sensitive nature was not equal to the strain of violent controversy, and brooding over his wrongs brought on insanity and death." How Charles White dealt with opposition he showed in 1790, when after 36 years of service to the Manchester Infirmary he resigned his post of visiting surgeon, together with his son Thomas and all his colleagues, because he disagreed with the decision of the trustees to appoint additional members of the honorary staff.8 But in the same year he founded the Manchester and Salford Lying-In Charity, which later became St Mary's Hospital. In later years White became interested in natural history and published papers on regeneration of animal substances, the natural history of the cow, different kinds of forest trees, and a most remarkable book, An Account of the Regular Gradation in Man and in Different Animals and Vegetables. This book, published when he was 71, is not, as the title might suggest, an anticipation of modern theory of evolution, but rather a demonstration of "progress in creation" of fixed and immutable species. But it does contain a new anthropological discovery: a gradation in the proportional length of forearm to upper arm in different races of man and apes. 9 When he was 83 White retired to his "little villa in Sale in Cheshire," which had belonged to his father. Here he could continue his interest in natural history, particularly forest trees, but in the following year he became totally blind, and after being confined to bed for five months he died on 20 February 1813 at the age of 84, finishing (in the words of Thomas Henry) "a long life of unremitting exertion and of great and extensive usefulness." In 1965, the centenary of the death of Ignaz Semmelweiss, his memory was honoured throughout the world. Charles White, who preceded his work by 70 years, deserves equal honours. References Cullingworth, C J, Charles White, FRS-a Great Provincial Surgeon.
A useful life
Why has Charles White not received the recognition that he undoubtedly deserves ? Is it because his life was essentially a success story-de Quincey calls him "the most eminent surgeon by much in the North of England"-whereas Semmelweiss's life ended in tragedy? The characters of the two men could not have been more different. In the words of Thomas Henry6 "Mr White was admirably fitted, both by his bodily constitution and by the qualities of his mind, for the successful exercise of the profession in which he was engaged. Even in advanced age he was capable of performing, without fatigue, very long
What are the dangers to the health of the occupants of a house where eight cats are kept indoors all the time ?
Generally, cat diseases do not affect people; there are, however, some exceptions. There is a condition known as cat scratch fever. No causal organism has been identified with this disease, nor has any evidence been found of illness among the cats that did the scratching. In certain circumstances cat scratches in people become inflamed, and the lymph nodes in the vicinity may swell. These lesions often appear two to three weeks after the actual scratch. The condition is rarely serious but may be troublesome, and a doctor should certainly be consulted. In urban areas cats may acquire infections of ringworm from mice or other cats and transmit these to people. Cats may be infected without showing visible signs of disease: the microsporum species that infects cats is particularly difficult to diagnose without special apparatus.
London, Glaisher, 1904. Adami, J G, Medical Library and Historical_Journal, 1907, 5, 1. Earles, M P, personal communication. I Welch, Collette, Wellcome Museum, personal communication. 5 Semmelweiss, I P, Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers. Vienna, Hartleben, 1861. 6 Henry, T, Memoirs of the Literary and Philosophical Society of Manchester, 1819, 3, 33. 7 Garrison, F H, History of Medicine. Philadelphia and London, Saunders, 1924. 8 Brockbank, E M, Sketches of the Lives and Work of the Honorary Medical Staff of the Manchester Infirmary. Manchester, University Press, 1904. 9 Cunningham, D J, Anthropology in the 18th Century. Presidential address to the Royal Anthropological Institute of Great Britain and Ireland, 2 3
Toxocara cati is a common parasite of cats. Mature parasites in the small intestine lay eggs that pass in the faeces to the ground where they embryonate and become fully infective after four or more days. Under favourable conditions the eggs may remain infective for nearly a year. When eaten by animals, including people, the eggs hatch and penetrate the gut wall to reach the lungs via the blood stream. Young children are particularly likely to eat soil contaminated with embryonated eggs. The human symptoms depend on the infective dose; generalised symptoms of pneumonia follow a massive dose, and fatal encephalitis and serious eye lesions have been recorded. Eight cats kept indoors in a house all the time could cause additional problems, in particular those of hygiene and sanitation. One authority has stated that three cats is a safe number for a medium-sized house with a garden and two the maximum for a flat. Scott, W N, Biology and Human Affairs, 1967, 32, 2. Scott, Patricia, Behaviour, Practical Guide to Cats. London, Hamlyn, 1976.