2 7 2
PERCIVALL POTT PERFORMS A POSTMORTEM
THOMAS R. FORBES, Ph.D. Section of Gross Anatomy, Department of Surgery Yale University School of Medicine New Haven, Conn.
p ERCIVALL POrTT (I714-I788), a leading British surgeon of the i8th century, began his extensive experience at the dissecting table in I 729 in London when he was apprenticed to Edward Nourse, a private lecturer in anatomy.* When Pott had acquired the necessary skill, he was given the task of preparing dissections for Nourse to demonstrate during his lectures. Pott's interest in anatomy continued, greatly influencing and contributing to his surgical prowess. In 1753 he and William Hunter were elected the first Masters of Anatomy of the new Corporation of Surgeons of London.1'2 Pott published a book on head injuries in 1768. The work was subsequently modified, the I773 edition appearing as Observations on the Nature and Consequences of Those Injuries to Which the Head is Liable from External Violence.3 His presentation was illustrated with the case histories of 43 patients.t Twenty-four of the latter did not survive, and the heads of 20 of these were opened for postmortem examination. If the remainder of the body underwent autopsy, no mention is made of the fact. In any event, Pott carefully attempted to relate gross anatomical findings to the cause of the injury, the treatment of the patient, and the course of the illness. His approach was that of the clinician rather than the pathologist. This research was suplported in part by Public Health Service Research Grant 1 ROI LM01538-02 from the National Library of Medicine, Bethesda, Md. *InLter Pott wvas to become famnous not only for his skill as an operator but for his first account of congenital hernia (1756), his descriptions of the fracture (1765) and the disease (1779) with which his name is now associated, and his observation on the frequency of scrotal cancer in chimney sweeps (1775)-one of the earliest reports of an occupational cancer. tFourtecn of the head injuries were occupational in origin and nine were caused by assaults. Twenty were due to falls from horses, wagons, coaches, scaffolds on buildings, a window, stairs, a ladder, etc. Less frequent causes included kicks by horses, sports (cudgels, cricket bats, a quoit), and machinery. One innocent victim was knocked down by a mob trying to rescue a man from a press gang. All but nine of thle patients were males, and at least 15 had not reached adulthood.
Bull. N. Y. Acad. Med.
PERCIVALL POTT PERFORMS A POSTMORTEM7
2
73
Unfortunately the Observations does not include a general comment on the frequency or importance of autopsies. More than a century before, William Harvey had conducted a postmortem examination of the body of Thomas Parr, who died at the reputed age of 152 years and nine months,4 but records of such autopsies in Britain before about 1770 are almost as rare as sesquicentenarians. As for the introduction of information from postmortems at coroners' inquests, England is said to have lagged at least five centuries behind some continental countries.5 6 There is no record of such evidence at British inquests before the I7th century; even then it was exceptional.* Few accounts of postmortem examinations for legal purposes in the I 700s have been discovered. Ackerknecht has stated that British contributions to legal medicine in the i8th century are negligible,7 but the observations of William and John Hunter should not be overlooked. 8,9 Against this background, the medical deposition of Percival Pott at an inquest in 1767 and his testimony at the subsequent trial are of interest. The inquisition, the legal document that summarized the inquest and was signed by the coroner and his jury, has not come to light, but the depositions of the witnesses are preserved among the General Sessions Papers at the Corporation of London Records Office. The inquest was held on May 6 in the Parish of St. Mlartin-in-the-Fields, Liberty of Westminster, County of Middlesex, before Thomas Prickard, coroner. The deceased was Mary Gardiner, hired a week before her death as a servant to Mistress Ellison of Broad Court. At the inquest another woman servant deposed that about 9 P.M. on May 5 Mistress Ellison and a friend, Thomas Sxvinhoe, returned to her home and dined on cold roast beef and salad. Mistress Ellison accused Mary Gardiner of having given away some of the beef. An hour or so later, while both servants were still angrily discussing the accusation, Mary remarked that "He [Swinhoe] is wvorse than she." Unfortunately this comment was overheard by the mistress and her guest. Swinhoe came down into the kitchen, there wvas an unpleasant verbal exchange, and he struck Mary on the left cheek with his open hand as the other servant looked on. Mary staggered and fell back onto the stone floor of the kitchen, Iying there without speech or motion and bleeding from *In my still incomplete study of coroners' inquests, of 106 deaths lby violence in London between 1673 and 1761 there is a record of the opening of at least a part of the body for medical examination in only 11 cases.
Vol. 51, No. 2, February 1975
2 74
T. R. FORBES R. FORBES
T.
a cut on the back of her head. She was lifted into a chair and the cut was dressed. About midnight she was carried to her own room. Swinhoe went out to search for a surgeon but was unsuccessful. An hour or so later Mary was found dead on her bed. Swinhoe tried in vain to bleed her, and left once again, much distressed, to look for a surgeon. The deponent added that Swinhoe and Mary had not quarreled before, that she appeared before the assault to be sober and in good health, and that in the two months the deponent had known Mary she had not been subject to fits. James Earle, a surgical pupil of Percivall Pott at St. Bartholomew's Hospital, testified to finding a wound one inch long and half an inch wide on the back of Mary's head after her death.* Pott deposed that he, like Earle, had examined the head of the deceased on the day of the inquest. He observed the wound on the back of the head and found no injury to the skull. Hle then exposed the brain "and did not find any Mischief done to the Brain or its Coverings, nor any apparent Cause of Death clearly Deducible from the Accident." Next he Examined the Body of the Deced very carefully within and without, and did not find any, the smallest Cause for a Suspicion that her Death was occasioned by violence, But on the other hand Says that there were several Marks of the Deced being in a very diseased State, particularly a considerable Quantity of WVater in the Cavity of the Thorax, and a very diseased state of the uterus and parts adjoining. A woman lodger at Mistress Ellison's deposed that about 8 P.mv., shortly before the assault, Mary Gardiner was "in Liquor, and Staggered, and not able to give this Dept. a reasonable answer. . . ." and that another woman had once, weeks before, seen Mary having a fit. A previous employer of Miary said that he had once watched her during a fit, from which she recovered in five or IO minutes. She had been, he said, a good servant but was sometimes drunk. On June 3, 1767 Thomas Swinhoe, or Swinner, came to trial at the Sessions of Gaol Delivery for the County of Middlesex, charged with *Earle (1755-1817) was himself to become a distinguished surgeon. He must have been precocious to be a pupil of Pott at the age of 129 and to be elected an assistant surgreon in 1770, at the age of 15, at St. Bartholomew's. One third of the operations there were performed by himi between 1776 and 178a. Later he was to become surgeon extraordinarv to George III, president of the College of Surgeons, and Pott's son-in-law and
bioriapher.10
Bull. N. Y. Acad. Med.
PERCIVALL POTT PERFORMS A POSTMORTEM
2 7 5
manslaughter "in slaying Mary Gardiner." He pleaded not guilty. A witness related essentially the same account of Mary's death as had been given at the inquest. The report of Percivall Pott's findings at the postmortem was somewhat more detailed than his deposition at the inquest in that he reported that he removed the "membrane" (dura mater) in order to inspect the brain. He added that the morning after his first examination he . . . received a letter from the Coroner, signifying the Jury were not satisfied with the examination of the head only, but desired I would examine the whole body, imagining she might receive some injury on some other part. . . . There was no apparent reason why she should die of the fall. I have great reason to think she had lived a very intemperate life, and that a disease was brought on herself by intemperance, which was the cause of her death. Thomas Swinhoe was found not guilty."1 It is unfortunate that Pott was, apparently by choice, so vague as to the disease arising from "intemperance." He may have meant to suggest chronic alcoholism or venereal infection. The "diseased state of the Uterus and parts adjoining" could have been relevant to the latter. Pott did not feel that the blow or fall had been fatal, and he did not really explain the sudden death of Mary Gardiner. ACKNOWLEDGMENT I am indebted to Miss Betty Masters, Deputy Keeper of the Records, Corporation of London, and her staff for their generous assistance. Transcripts of Crown-copyright records in the Corporation of London Records Office appear by permission of H. M. Stationery Office. REFERENCES 1. Lee, S., editor: Dictionary of National Biography. New York, Macmillan, 1909, vol. 16, pp. 207-11. 2. Dobson, J.: John Hunter. Edinburgh, Livingstone, 1969, p. 28. 3. Pott, P.: Observations on the Nature and Consequences of Those Injuries to Which the Head is Liable from Exteriatl Violenzce. London, Hiaswes, Clarke, and Collins, 1773.
Vol. 51, No. 2, February 1975
-4. Harvey, W.: 'The Anatomical Examination of the Body of Thomas Parr.... In: Willis, R.: The Works of William Harvey, M.D. London, Sydenhani Soc., 1847, pp. .589-92. 5. Davis, B. T.: George Edward Male, M.D.--'The father of English medical jurisprudence. Proc. Roy. Soc. Med. q7:117-20, 1974. 6. Harvard, J. D. J.: The l)etection of
2 7
6
T. R. FORBES
Secret Homicide. London, Macmillan, 1960, pp. 1-5, 8. 7. Ackerknecht, E. H.: Legal Medicine in Transition (16th-18th Centuries). In: History of Legal Medicine. Ciba Symposia 11:1290-98, 1950. 8. Hunter, W.: On the uncertainty of the signs of murder in the case of bastard children. Med. Observ. Inq. 6:266-90, 1784.
9. Forbes, T. R.: Two new John Hunter manuscripts. Guildhall Studies London Hist. 1:24-27, 1973. 10. Stephen, L., and S. Lee, editors: Dictionary of National Biography. New York, Macmillan, 1908, vol. 6, p. 320. 11. [Anon.]: Old Bailey Sessions Papers. London, Wilkie, 1766-1767, case no. 333, p. 215.
Bull. N. Y. Acad. Med.
PERCIVALL POTT PERFORMS A POSTMORTEM
THOMAS R. FORBES, Ph.D. Section of Gross Anatomy, Department of Surgery Yale University School of Medicine New Haven, Conn.
p ERCIVALL POrTT (I714-I788), a leading British surgeon of the i8th century, began his extensive experience at the dissecting table in I 729 in London when he was apprenticed to Edward Nourse, a private lecturer in anatomy.* When Pott had acquired the necessary skill, he was given the task of preparing dissections for Nourse to demonstrate during his lectures. Pott's interest in anatomy continued, greatly influencing and contributing to his surgical prowess. In 1753 he and William Hunter were elected the first Masters of Anatomy of the new Corporation of Surgeons of London.1'2 Pott published a book on head injuries in 1768. The work was subsequently modified, the I773 edition appearing as Observations on the Nature and Consequences of Those Injuries to Which the Head is Liable from External Violence.3 His presentation was illustrated with the case histories of 43 patients.t Twenty-four of the latter did not survive, and the heads of 20 of these were opened for postmortem examination. If the remainder of the body underwent autopsy, no mention is made of the fact. In any event, Pott carefully attempted to relate gross anatomical findings to the cause of the injury, the treatment of the patient, and the course of the illness. His approach was that of the clinician rather than the pathologist. This research was suplported in part by Public Health Service Research Grant 1 ROI LM01538-02 from the National Library of Medicine, Bethesda, Md. *InLter Pott wvas to become famnous not only for his skill as an operator but for his first account of congenital hernia (1756), his descriptions of the fracture (1765) and the disease (1779) with which his name is now associated, and his observation on the frequency of scrotal cancer in chimney sweeps (1775)-one of the earliest reports of an occupational cancer. tFourtecn of the head injuries were occupational in origin and nine were caused by assaults. Twenty were due to falls from horses, wagons, coaches, scaffolds on buildings, a window, stairs, a ladder, etc. Less frequent causes included kicks by horses, sports (cudgels, cricket bats, a quoit), and machinery. One innocent victim was knocked down by a mob trying to rescue a man from a press gang. All but nine of thle patients were males, and at least 15 had not reached adulthood.
Bull. N. Y. Acad. Med.
PERCIVALL POTT PERFORMS A POSTMORTEM7
2
73
Unfortunately the Observations does not include a general comment on the frequency or importance of autopsies. More than a century before, William Harvey had conducted a postmortem examination of the body of Thomas Parr, who died at the reputed age of 152 years and nine months,4 but records of such autopsies in Britain before about 1770 are almost as rare as sesquicentenarians. As for the introduction of information from postmortems at coroners' inquests, England is said to have lagged at least five centuries behind some continental countries.5 6 There is no record of such evidence at British inquests before the I7th century; even then it was exceptional.* Few accounts of postmortem examinations for legal purposes in the I 700s have been discovered. Ackerknecht has stated that British contributions to legal medicine in the i8th century are negligible,7 but the observations of William and John Hunter should not be overlooked. 8,9 Against this background, the medical deposition of Percival Pott at an inquest in 1767 and his testimony at the subsequent trial are of interest. The inquisition, the legal document that summarized the inquest and was signed by the coroner and his jury, has not come to light, but the depositions of the witnesses are preserved among the General Sessions Papers at the Corporation of London Records Office. The inquest was held on May 6 in the Parish of St. Mlartin-in-the-Fields, Liberty of Westminster, County of Middlesex, before Thomas Prickard, coroner. The deceased was Mary Gardiner, hired a week before her death as a servant to Mistress Ellison of Broad Court. At the inquest another woman servant deposed that about 9 P.M. on May 5 Mistress Ellison and a friend, Thomas Sxvinhoe, returned to her home and dined on cold roast beef and salad. Mistress Ellison accused Mary Gardiner of having given away some of the beef. An hour or so later, while both servants were still angrily discussing the accusation, Mary remarked that "He [Swinhoe] is wvorse than she." Unfortunately this comment was overheard by the mistress and her guest. Swinhoe came down into the kitchen, there wvas an unpleasant verbal exchange, and he struck Mary on the left cheek with his open hand as the other servant looked on. Mary staggered and fell back onto the stone floor of the kitchen, Iying there without speech or motion and bleeding from *In my still incomplete study of coroners' inquests, of 106 deaths lby violence in London between 1673 and 1761 there is a record of the opening of at least a part of the body for medical examination in only 11 cases.
Vol. 51, No. 2, February 1975
2 74
T. R. FORBES R. FORBES
T.
a cut on the back of her head. She was lifted into a chair and the cut was dressed. About midnight she was carried to her own room. Swinhoe went out to search for a surgeon but was unsuccessful. An hour or so later Mary was found dead on her bed. Swinhoe tried in vain to bleed her, and left once again, much distressed, to look for a surgeon. The deponent added that Swinhoe and Mary had not quarreled before, that she appeared before the assault to be sober and in good health, and that in the two months the deponent had known Mary she had not been subject to fits. James Earle, a surgical pupil of Percivall Pott at St. Bartholomew's Hospital, testified to finding a wound one inch long and half an inch wide on the back of Mary's head after her death.* Pott deposed that he, like Earle, had examined the head of the deceased on the day of the inquest. He observed the wound on the back of the head and found no injury to the skull. Hle then exposed the brain "and did not find any Mischief done to the Brain or its Coverings, nor any apparent Cause of Death clearly Deducible from the Accident." Next he Examined the Body of the Deced very carefully within and without, and did not find any, the smallest Cause for a Suspicion that her Death was occasioned by violence, But on the other hand Says that there were several Marks of the Deced being in a very diseased State, particularly a considerable Quantity of WVater in the Cavity of the Thorax, and a very diseased state of the uterus and parts adjoining. A woman lodger at Mistress Ellison's deposed that about 8 P.mv., shortly before the assault, Mary Gardiner was "in Liquor, and Staggered, and not able to give this Dept. a reasonable answer. . . ." and that another woman had once, weeks before, seen Mary having a fit. A previous employer of Miary said that he had once watched her during a fit, from which she recovered in five or IO minutes. She had been, he said, a good servant but was sometimes drunk. On June 3, 1767 Thomas Swinhoe, or Swinner, came to trial at the Sessions of Gaol Delivery for the County of Middlesex, charged with *Earle (1755-1817) was himself to become a distinguished surgeon. He must have been precocious to be a pupil of Pott at the age of 129 and to be elected an assistant surgreon in 1770, at the age of 15, at St. Bartholomew's. One third of the operations there were performed by himi between 1776 and 178a. Later he was to become surgeon extraordinarv to George III, president of the College of Surgeons, and Pott's son-in-law and
bioriapher.10
Bull. N. Y. Acad. Med.
PERCIVALL POTT PERFORMS A POSTMORTEM
2 7 5
manslaughter "in slaying Mary Gardiner." He pleaded not guilty. A witness related essentially the same account of Mary's death as had been given at the inquest. The report of Percivall Pott's findings at the postmortem was somewhat more detailed than his deposition at the inquest in that he reported that he removed the "membrane" (dura mater) in order to inspect the brain. He added that the morning after his first examination he . . . received a letter from the Coroner, signifying the Jury were not satisfied with the examination of the head only, but desired I would examine the whole body, imagining she might receive some injury on some other part. . . . There was no apparent reason why she should die of the fall. I have great reason to think she had lived a very intemperate life, and that a disease was brought on herself by intemperance, which was the cause of her death. Thomas Swinhoe was found not guilty."1 It is unfortunate that Pott was, apparently by choice, so vague as to the disease arising from "intemperance." He may have meant to suggest chronic alcoholism or venereal infection. The "diseased state of the Uterus and parts adjoining" could have been relevant to the latter. Pott did not feel that the blow or fall had been fatal, and he did not really explain the sudden death of Mary Gardiner. ACKNOWLEDGMENT I am indebted to Miss Betty Masters, Deputy Keeper of the Records, Corporation of London, and her staff for their generous assistance. Transcripts of Crown-copyright records in the Corporation of London Records Office appear by permission of H. M. Stationery Office. REFERENCES 1. Lee, S., editor: Dictionary of National Biography. New York, Macmillan, 1909, vol. 16, pp. 207-11. 2. Dobson, J.: John Hunter. Edinburgh, Livingstone, 1969, p. 28. 3. Pott, P.: Observations on the Nature and Consequences of Those Injuries to Which the Head is Liable from Exteriatl Violenzce. London, Hiaswes, Clarke, and Collins, 1773.
Vol. 51, No. 2, February 1975
-4. Harvey, W.: 'The Anatomical Examination of the Body of Thomas Parr.... In: Willis, R.: The Works of William Harvey, M.D. London, Sydenhani Soc., 1847, pp. .589-92. 5. Davis, B. T.: George Edward Male, M.D.--'The father of English medical jurisprudence. Proc. Roy. Soc. Med. q7:117-20, 1974. 6. Harvard, J. D. J.: The l)etection of
2 7
6
T. R. FORBES
Secret Homicide. London, Macmillan, 1960, pp. 1-5, 8. 7. Ackerknecht, E. H.: Legal Medicine in Transition (16th-18th Centuries). In: History of Legal Medicine. Ciba Symposia 11:1290-98, 1950. 8. Hunter, W.: On the uncertainty of the signs of murder in the case of bastard children. Med. Observ. Inq. 6:266-90, 1784.
9. Forbes, T. R.: Two new John Hunter manuscripts. Guildhall Studies London Hist. 1:24-27, 1973. 10. Stephen, L., and S. Lee, editors: Dictionary of National Biography. New York, Macmillan, 1908, vol. 6, p. 320. 11. [Anon.]: Old Bailey Sessions Papers. London, Wilkie, 1766-1767, case no. 333, p. 215.
Bull. N. Y. Acad. Med.
