“The time has almost passed away for sneering at girls desiring the advantage of higher education”: Frances Hoggan (1843-1927)

Each year since 2016 the Learned Society of Wales has awarded the Frances Hoggan Medal. This recognises and celebrates the contribution of outstanding women connected with Wales in the areas of science, medicine, engineering, technology or mathematics.  The medal is named for one of the most remarkable women in early medicine, who like her contemporaries, Elizabeth Garrett Anderson and Elizabeth Blackwell, helped pave the way for women everywhere in medical education and practice.

Frances Hoggan was born in Brecon and even at the age of 15 she must have been been determined to succeed for she left home in Wales to pursue higher education, first in Paris and then Düsseldorf.  She returned at the age of 23, fully intent on following a medical career. 

Being excluded from university medical courses, the only route open for women to obtain a license to practise medicine in England and Wales was through the examining authority, the Society of Apothecaries.  Elizabeth Garrett Anderson had obtained the Licentiate of the Society in 1865, becoming the first woman to do so.  Hardly welcoming to women, the Society had sought legal advice to prevent Anderson taking the exam but were compelled to allow her.  Shortly after Hoggan passed the preliminary exams in 1867, the Society closed the loophole and formally excluded women from its professional examinations.

Thus, Hoggan could not follow suit and was forced again to continue her education in Europe.  The University of Zurich admitted women, and Hoggan passed the entrance exams and enrolled in the Medical Faculty.  She completed the six-year course in just three and graduated with her MD in March 1870.  She was only the second woman to obtain a European MD and the first British woman to do so.  This time she beat her contemporary Garrett Anderson to the honour by three months.

After graduating, she continued her studies in Europe, before returning to England in 1874 where she married fellow doctor, George Hoggan, with whom she would later form the first husband and wife medical practice.  However, at the time of her marriage she was still unable to practise because those with foreign degrees were excluded from the medical register—a regulation specifically designed to block women.

With a change in the law, Hoggan finally obtained her license to practise in the UK from The King’s and Queen’s College of Physicians of Ireland in February 1877. Three years later, she became the first female member of the new Royal College of Physicians of Ireland, even though the BMA to which she had been elected in 1875, stripped her of her membership in 1878 after a poll of its overwhelmingly male electorate.

Hoggan’s skin was undoubtedly thickened by necessity, and she remained undaunted by these setbacks.  She specialised in women’s and children’s medicine and continued her research career, writing many papers in English, French and German. She also campaigned for the medical education of women and later for the educational rights of girls and women in general. Throughout the 1880s she advocated the benefits of university education for women at a time when the President of the BMA had stated higher education was a danger to women’s health. He argued such mental exertion would damage their reproductive systems and impact on their ability to be mothers.

Unsurprisingly, Hoggan vigorously disagreed and argued that university scholarships should be equally available to both sexes, writing, “The time has almost passed away for sneering at girls desiring the advantage of higher education; and I am sure all…could point to more than one girl, no less promising than her clever brother, to whom the possibility of gaining a scholarship…would mean just the difference between a life of monotonous drudgery in an uncongenial home, and a life of honourable and useful independence…”

Hoggan’s life changed abruptly when her husband became ill, and they moved for his health to France.  He would die there of a brain tumour leaving Frances a widow at 47.  For the next 30 years Hoggan devoted herself to international education and social reform especially in South Africa, India and the US, and became a tireless critic of racism.

Frances and George Hoggan had no children, but Frances shared much of her life with her youngest sister.  Elise Morgan was born in Brussels when Frances was 17 and studying in Paris.  Whether she was really the daughter of the teenage Frances, as has been suggested, we will never know, but to have openly acknowledged her as an illegitimate child would doubtless have stopped her education and any hope of a medical career in its tracks. Frances Hoggan’s career was already a series of apparently insurmountable battles which, through dogged determination, she would win, one by one, and her contribution to the recognition of women in medicine remains her outstanding legacy.

Sources

© Allan Gaw 2022

This article was originally published in the MDDUS online magazine, Insight.

If you want to read more of my writing on the history of medicine, research and law, try these books. All are available on kindle, and if you’re on Kindle Unlimited, they’re free to download.

“Nutrition as a subject did not exist when I started”: Elsie Widdowson (1906-2000)

Although remembered now as one of the most honoured female scientists in the UK and a ground-breaking nutritionist, Elsie Widdowson towards the end of her life was keen to point out the convoluted professional journey she had taken. “Nutrition as a subject did not exist when I started. I have been a chemist, biochemist, plant physiologist, medical researcher and a physiologist.”

She was born in Edwardian England and raised during the First World War in a modest home in Dulwich. Her father was a shopkeeper and her mother a dressmaker, and Widdowson and her younger sister cycled to Sydenham High School each day. Both sisters were academically gifted, and both went to university to study sciences. Widdowson opted for chemistry while her sister trained as a physicist. After she obtained her first degree at Imperial College, London, Widdowson stayed on to continue her studies for her PhD.  There, she analysed the composition of sugars in developing apples, and indeed much of her early work involved meticulous biochemical laboratory work on plants. 

During her post-doctoral work, she was advised that dietetics was a developing field which might offer her employment. She noted, “I didn’t really want to be a dietitian but jobs in research were hard to come by for beginners in the early 1930s,” so she enrolled on a postgraduate course at King’s College Hospital.  It was there that she would first meet her lifelong research partner, Robert McCance.  He was a junior doctor at the time and Widdowson had no compunction in pointing out that his methods for estimating the carbohydrate content of fruits were erroneous. He clearly recognised her qualities as a scientist immediately because, instead of taking umbrage, he arranged for a grant to fund her to work with him on correcting his data.  Thus began a scientific partnership that would last the next 60 years and transform the study of nutrition and dietetics.

McCance and Widdowson complimented each other scientifically and, in particular, she brought her consummate experimental skills to the partnership as well as her meticulous attention to detail.  Their names are forever linked in nutrition circles because of their work on what has become the bible of dietary analysis—McCance & Widdowson’s The Composition of Foods.  These food tables, now in their seventh edition, were formulated from the results of thousands of labour-intensive analyses and first published in 1940.  They quickly became the core database for dietetic practice throughout the world and their timely publication meant they could also inform government policy on wartime rationing.

At the outbreak of the war, McCance and Widdowson having moved to Cambridge the year before, now turned their efforts to understanding the impact of food rationing on the British public. To test whether the meagre allowances could sustain health, she and the team rigidly adhered to the rations for three months. They reported no problems but questioned whether those expending much greater energy than scientists might be less fortunate. To address that issue, the team hiked through the Lake District in winter for ten days eating little more than brown bread. Such an experiment typified Widdowson’s pragmatic approach to research and her frequent self-experimentation. While conscious of the information that could be provided by animal studies, Widdowson was highly critical of those who tried to answer questions of human nutrition only by studying mice.

During the war, she and her colleagues also studied the nutritional content of the British loaf. They were concerned about the available calcium in bread and Widdowson’s work led to the fortification of most bread with calcium carbonate—a practice that continues to this day.

After the war she consulted on the dietary requirements of the Nazi concentration camp survivors and worked in Germany for three years on childhood nutrition. Later she would become the President of the Nutrition Society, a Fellow of the Royal Society and in 1993 a Companion of Honour.

She only retired properly in her late eighties, and she was finally able to spend more time in her thatched cottage in Barrington where she lived until her death tending her orchard, her vegetable garden and her cats. 

Those who worked with her all remarked on her energy and vigour even into what for others would be old age.  She maintained her interest and was always ready to embrace new ideas and technology even though she would remark that despite every modern advantage, scientific progress was no faster than in her early days at the laboratory bench. Then she had nothing more than elementary equipment and a slide rule, but she still managed through great effort and steadfast dedication to the task to build a discipline and change the way we think about nutrition.

Sources

  • Obituary, The Guardian, 22 June 2000.
  • Ashwell M. McCance & Widdowson – A Scientific Partnership of 60 Years. London: British Nutrition Foundation; 1993.
  • Southgate D. Proc Nut Soc 2001; 60: 157–60.

© Allan Gaw 2022

This article was originally published in the MDDUS online magazine, Insight.

If you want to read more of my writing on the history of medicine, research and law, try these books. All are available on kindle, and if you’re on Kindle Unlimited, they’re free to download.

“The first lady member” Lilian Lindsay (1871-1960): First woman to qualify in dentistry in the UK

Left standing on the pavement, the 21-year-old Lilian Murray was willing to endure the indignity to achieve her dream. It was there on Great Portland Street outside the National Dental Hospital in London, that the Dean of the Dental School had chosen to interview her because he would not even allow women inside the building, never mind entry on to his courses.  Not surprisingly, he rejected her application outright.

Born in London into a large family, she had first expressed her desire to become a dentist while at the Camden School for Girls.  Her headmistress there had told her that she “was destined to be a teacher of the deaf and dumb.” Perhaps because of her outrage at having her future decided for her in this way, or because of her aversion to teaching, she stood her ground.  The headmistress was equally adamant and informed her, “Then I will prevent you from doing anything else,” and revoked her scholarship forthwith, forcing her out of the school.  

She left, but through a family connection she found a three-year apprenticeship in dentistry which took her part of the way towards her goal, but she knew that she needed to study at a Dental School. While that rejection on the street might have thwarted others, she redoubled her efforts and decided to apply to the Edinburgh Dental Hospital and School, which she had been told had a more enlightened attitude when it came to the admission of women students.  To her delight she was accepted in 1892, but not everyone was as happy.  One distinguished medical academic there, Sir Henry Littlejohn, told her, “I am afraid, Madam, you are taking the bread out of some poor fellow’s mouth.” Such a chauvinistic argument was commonplace at the time, but she had no truck with it, and when she commenced her studies, she was the only female student on the course.  

On her first day, she met one of her teachers, the dentist Robert Lindsay, whom she would later marry.  Academically, she excelled and graduated with honours in 1895, winning medals for dental surgery & pathology and materia medica & therapeutics along the way. The President of the British Dental Association (BDA) welcomed her as “the first lady member” on 2 November 1895. It would be another 17 years before the first graduate of an English Dental School would join her.

She began her busy dental practise in London, not far from the house in which she grew up in Holloway and worked there for the decade it took her to repay her student loans.  In 1905, she married Lindsay, and they moved to Edinburgh where they set up practice together for the next 14 years.  In 1919, her husband was appointed Secretary to the BDA and the couple retired from clinical practice and moved to London to live in a flat above the shop at the Association’s headquarters on Russell Square. She took the role of the Association’s Honorary Librarian and effectively build the country’s first dental library from scratch.  Over the next thirty years, her efforts would make it one of the foremost libraries of its kind in the world.  At this time, she also developed her interest in dental history and began amassing objects and materials that would form the foundation of the Dental Museum.  She would go on to write a book and over 50 articles on the subject, the most celebrated of which was her own translation of the classic text by Pierre Fauchard, Le Chirurgien Dentiste (The Dental Surgeon). Such was her devotion to historical research and the library she had built, that she refused to leave London even during the height of the Blitz, saying she could not work away from the books.

Her husband died in 1930, but she continued her work with the BDA, becoming subeditor of the British Dental Journal in 1931. After first becoming the President of the British Society for the Study of Orthodontics in 1938, she was elected the first female President of the Association in 1946.  It would be another 47 years before they elected their second.

In her seventies, she received many honours including an honorary doctorate from her alma mater, a fellowship from the Royal College of Surgeons and a CBE, and she spent her final years in Suffolk where she died aged 88.

Lilian Lindsay could have given up when she was left alone on that pavement on Great Portland Street in 1892, with her dreams of becoming a dentist shattered. Instead, she forged a pioneering role in what was at the time a male profession, and she paved the way for significant changes.  A century after her birth, around a quarter of all new dentists in the UK were women and today more than half of all dental students are female.

Sources: 

  • English Heritage, Blue Plaques, Lilian Lindsay.
  • University of Edinburgh, Alumni in History.
  • Cohen E, Cohen RA. British Dental Journal 1991, 171, 325.
  • Haines, CMC. International Women in Science: a Biographical Dictionary to 1950, 2001, ABC-CLIO, Santa Barbara.
  • Teli S. Soundbite, 19 June 2014.

© Allan Gaw 2022

This article was originally published in the MDDUS online magazine, Insight.

If you want to read more of my writing on the history of medicine, research and law, try these books. All are available on kindle, and if you’re on Kindle Unlimited, they’re free to download.

“Understanding, evaluating, and cultivating health” Innes Hope Pearse (1889-1978)

It may seem a paradox to suggest that the medical profession should not be overly concerned with illness, but that was the central belief of two doctors who first put their theories into practice between the wars.

Innes Hope Pearse was born and spent her formative years in Surrey, the child of a middle-class family.  At the turn of the century, she began her medical studies at the London School of Medicine for Women where she graduated in 1915. She was a House Physician at the London Hospital and later became one of the first female Registrars at the Royal Free.  It was there, while working on a research project in 1921, that she met George Scott Williamson, a Scottish pathologist who would become her professional and personal partner in life.

Although from different medical backgrounds, Pearse and Williamson found they had much in common when they considered the profession in which they worked.  Both thought doctors needed to prioritise “understanding, evaluating, and cultivating health” but they also knew that they were ill-equipped to do so without further research.  They began to see themselves as biologists wishing to study the natural history of health in the same way that many before them had studied disease.

Jointly, they decided to put their thinking into practice and in 1926 they launched the first three year phase of their studies in a house in Peckham.  This would essentially be the pilot for a larger project launched in 1935 in the purpose built Pioneer Centre.  They had chosen Peckham because its “populace roughly represents a cross-section of the total populace of the nation with as widely differing a cultural admixture as it is possible to find in any circumscribed metropolitan area.”

The Pioneer Centre was run as a club funded by a modest weekly subscription which entitled families to use a range of leisure facilities including a swimming pool and receive regular ‘health overhauls’.  These were screening clinics run by Pearse and her partner. The Centre was run by its members and there were few rules. Any structure was defined by the members themselves rather than imposed by the medical staff. 

The experiment was significantly interrupted by the outbreak of the Second World War and the concomitant disruption and dislocation of families in the Peckham area.  Attuned to the challenges that mothers and children would face when their husbands and fathers were mobilised, Pearse proposed a new solution.  She described a ‘homestead scheme’ to provide a healthy and useful life for the wives and children, claiming that “the family unit is the first casualty of war.” Some mothers from Peckham did move temporarily to the Kent farm that Pearse was already using to grow organic vegetables for members of the Pioneer Centre, but the homestead scheme never took off and was not endorsed by the authorities.

In the post war years, little objective proof could be provided for improvements in the vitality and health of the population as a result of the Experiment, and Pearse and Williamson were criticised for their lack of scientific rigour.  This undoubtedly had a detrimental impact on their requests for funding, which, together with their steadfast refusal to compromise their beliefs, led to the closure of the Centre in 1950.

Despite Pearse and her professional partner’s advocacy of the importance of marriage and the family unit, they did not practise what they preached. They worked together for over thirty years and although during that time they lived together as a couple, they had no children and did not marry until 1950, when they were both in their sixties.  Only three years later, Pearse’s husband died. She went on to work on his last unfinished book for the next twelve years publishing it in 1965. Her own final book, ‘The Quality of Life,’ would not be published until after her death in 1978 at the age of 89.

For Pearse, her work was all-consuming and over time her writings on the project became philosophical and verged on the spiritual. However, she would always maintain her scientific interest in the Peckham Experiment which she viewed as “a human laboratory.”  Many of their contemporaries saw Pearse and Williamson’s ideas as outlandish, but seen through 21st century eyes their beliefs—the importance of the social determinants of health, the holistic nature of well-being and even their early interest in organic farming to promote health—might seem remarkably prescient.

Sources

  • Brit Med J, 1979; 3 March: 630.
  • Brit Med J, 1941; 6 December: 820.
  • P. Conford. Med Hist. 2016; 60: 250-69.
  • J. Lewis & B. Brookes. Milbank Memorial Fund Quarterly, 1983 ; 61: 307-50.

© Allan Gaw 2022

This article was originally published in the MDDUS online magazine, Insight.

If you want to read more of my writing on the history of medicine, research and law, try these books. All are available on kindle, and if you’re on Kindle Unlimited, they’re free to download.

A Tug at the Sleeve

There are moments when history ceases to be a story. When things that you read about jump from the page and awkwardly occupy the present, instead of quietly staying in the past. When history reaches out and tugs at your sleeve.

On a late Spring walk through London, I was seeking out a memorial I had read about.  At the busy intersection of Cambridge Heath and Roman Roads, just across from the old church, there it was.  Seemingly hanging in the air was a wooden staircase carved with their names—one hundred and seventy-three men, women and children who had died in the worst civilian disaster of the Second World War.  I was standing outside the entrance to the Bethnal Green Tube Station where the suspended wooden staircase of nineteen memorial steps mirrors perfectly the real flight of steps that still leads down into the station beside it. 

On the night of 3 March 1943, people were making their way to the Bethnal Green shelter in the darkness of the blackout. The Tube Station was at the time unfinished, but it had been in use as a deep shelter for the previous three years of the war. At 8:17 pm that night, the air raid siren sounded and over the next ten minutes around two thousand people filed down the stairs to safety.  There was only a single entrance to the station down a narrow 3 metre wide, poorly lit stairway without handrails.  That night the concrete steps were also wet and slippery. And there were more people than usual trying to enter the shelter because three buses had just dropped all their passengers at the unsupervised station entrance. At 8:27 pm, there was a loud salvo of defensive rockets launched from the nearby battery in Victoria Park.  The crowd waiting to enter mistook the roaring sound for falling enemy bombs and surged forward.  A woman carrying a child stumbled on the third step from the bottom, an elderly man tripped and fell to her left and those behind fell like dominoes.  The crowd in the street above, still anxious to escape the air raid, pressed forward, unable to see what was unfolding at the foot of the stairs. Within seconds, the whole stairwell was filled with a tangled and immovable mass of three hundred bodies, lying five or six deep.

At the scene, one hundred and sixty-one people were pronounced dead and a further twelve would succumb to their injuries shortly afterwards.  Poignantly, sixty-two of the dead were children.  The local GP who examined the corpses at the scene found no evidence of fractures, only of soft tissue injuries, and recorded their cause of death as suffocation. The Bethnal Green Tube Station Disaster would be the largest civilian accident in the UK during the war and, in a single night, it would account for a third of all wartime deaths in the area.

I was now standing at the top of that staircase that led down into the gloom of the underground station. As I counted the steps, I tried to take it all in. Here I was on the very spot where it had all happened a lifetime ago. Suddenly, the moment was broken by a voice behind me.

“Excuse me.”

I turned to see that I was blocking the path of an elderly woman with a shopping cart which she was using as much as a walking aid as a carrier. I leapt out of the way and apologised.  She was stooped, almost bent double by the ravages of osteoporosis.  She positioned herself at the top of the nineteen steps and paused.  It looked to be a journey she made regularly and one where she relied routinely on the kindness of strangers to help her down the flight with her bag.  Today, it was my turn.

“Can I help you with that?”

“Oh, that would be kind.  Just pick it up from the bottom will you or the ’andle comes off.”

I did as I was bid and descended the fateful stairs, carrying the shopping cart.  I paused momentarily on the third step from the bottom where the woman carrying the baby had tripped.  However, I had my own load and I continued to the half landing where the stairs turned.  I looked back to see the old woman clinging to the handrail and gingerly making her way down behind me.  I quickly took the cart down the other half flight, deposited it at the bottom and went back up to the landing to offer her my arm.  She declined, but turned awkwardly and, doubtless not without pain, looked up at me. Then she tugged at my sleeve.

“That thing you were looking at upstairs.  I was there, you know.  Lost my school friends.  It was ’orrible.  Thanks for ’elping me wi’ the bag.”

She did not wait for a response. Still stooped, she walked on, pushing her cart through the ticket hall to the platforms beyond—a journey those classmates had never managed to complete almost eighty years before.

I stood on the landing for a moment, speechless, my head filled with the questions I would have liked to have asked. But then I felt a sudden need for air, and I turned and made for the sunshine.  As I climbed the nineteen steps, it was impossible not to think of those children, their parents and their grandparents. They had lain trapped by the weight of bodies over them, crushed to death on these very stairs that night in 1943.

The memorial to the Bethnal Green Tube Station Disaster is a beautiful and moving structure, but ultimately it is wood and metal and concrete.  What it represents, however, is what every historic memorial represents—people and pain.  It is easy to forget that those names etched or carved or painted on any roll of honour were living, breathing people.  Frightened mothers holding onto the hands of crying children; confused elderly men startled by the noise in the darkness; young school friends wearing hats and scarfs to keep out the cold and giggling at the nightgowns they were wearing under their coats. Easy to forget, that is, until one of the survivors tugs at your sleeve. A woman who, by sheer chance, was granted eighty more years of life than her school friends. A woman who would have been one of those carved names on the memorial if she had arrived at those stairs only a few seconds earlier. And whom I would have missed had I arrived only a few seconds later.

© Allan Gaw 2022

If you want to read more of my writing on the history of medicine, research and law, try these books. All are available on kindle, and if you’re on Kindle Unlimited, they’re free to download.

Irish Physician and Double Olympic Gold Medallist

On a summer’s day in 1928, a young Irishman stood in the Olympic stadium in Amsterdam.  Filled with emotion, he watched while the tricolour was raised as the strains of his national anthem were being played for the first time at such a ceremony.

Pat O’Callaghan was born in North Cork into a farming family with strong sporting links.  His two brothers were gifted athletes, so it was unsurprising that he would be too. However, initially it was his brains rather than his brawn that brought him to notice.  Academically he was precocious—starting school at two, winning a place at a prestigious academy at 15 and passing the matriculation examination at 16 enabling him to begin his medical studies at the Royal College of Surgeons of Ireland, in the same year that his homeland became the new Irish Free State. He graduated at the age of 20 but was considered too young to practise in Ireland, so he joined the Royal Air Force Medical Service and worked abroad.

All his life he had been a keen sportsman and was an all-round athlete enjoying particular success in hurling and football, but it was the hammer that caught his interest.  He was strong and tall—it is said that men from his area were descended from a race of giants—and he took to wielding and throwing the great weight further than anyone.  His first hammer was a cannon ball, liberated from Macroom Castle, to which a local blacksmith was persuaded to weld a chain. He competed with this home-made hammer even though it was much heavier than those used by his rivals, but this did not prevent him from winning every competition he entered.

Only 13 months after he started throwing the hammer, he had won the Irish title and was on his way to represent his country at the Olympics in Amsterdam. As a relative unknown, he progressed through the heats and going into the final he was in third place behind his main rival, the Swede Ossian Skiöld. For his final throw, O’Callaghan borrowed the Swede’s hammer. He won with a throw of 51.39m beating his own career best to date by a remarkable 51cm and his nearest rival on the day by 10cm.  The crowd of 20,000 in the stadium watched as history was made with Ireland winning its first ever gold medal.

He returned home to a hero’s welcome but quickly resumed his medical practice being appointed as Assistant Medical Officer at Clonmel District Mental Hospital in Tipperary.  However, he did not neglect his sports and in the 1930 National Championships he won not only in his Olympic discipline but also took the prizes in shot-putt, discus and high jump.

Two years later, O’Callaghan was the proud flag bearer for the Irish team as they entered the stadium in Los Angeles for the 1932 Olympics.  He was there to defend his title but got off to a rocky start.  He had come with spiked athletic shoes ready for the usual clay or grass hammer circle.  However, a cinder circle was provided in L.A. and his shoes caught on it preventing him from pivoting as he turned.  Despite this, by the final round, he was in second place. As his competitors made their throws, he spent his time filing down his spikes at the side of the field and with his final attempt, O’Callaghan made a throw of 53.92m to earn his second Olympic gold. While in L.A. he was invited by M.G.M. to play the lead in the next Tarzan movie, an offer he declined, preferring to return home to Ireland and to medicine. However, he would return to America in the summer of 1938 to the professional wrestling circuit, lured doubtless by the hugely lucrative deals he was offered when he was billed as ‘Dr Hercules’ and the ‘Adonis from Erin.’  He was successful but quickly found that professional wrestling was more about show business than sport, and he returned home once more.

In 1934 he set up in general practice in Tipperary where he would work for the next fifty years. He was a much-loved character being a renowned raconteur, fisherman and poacher, firmly believing the rivers and everything in them belonged to the people. He maintained a lifelong interest in athletics and in the Olympic movement. When he passed away, he was mourned not just by his community, but also the Irish Nation and the world of sport, and he was fondly remembered as a ‘gentle giant’ who was ‘always accessible’ and ‘ordinary in his greatness’.

Reflecting on that day in 1928 when he made history, O’Callaghan said of his Olympic triumph that he was glad of it, “not for…myself, but for the fact that the world has been shown that Ireland has a flag, that Ireland has a National Anthem, and, in fact we have a nationality.”

Sources

  • International Olympic Committee. www.olympics.com
  • Riordan, B.  Irish Examiner, August 1, 2018
  • Browne, B. Irish Independent News, December 19, 2020
  • Hannigan, D.  Irish Times, June 10, 2021

© Allan Gaw 2022

This article was originally published in the MDDUS online magazine, Insight.

If you want to read more of my writing on the history of medicine, research and law, try these books. All are available on kindle, and if you’re on Kindle Unlimited, they’re free to download.

“Against common right and reason”—The Case of Dr Bonham in 1610

Today, the consequences of practising medicine in the UK without registration and a license are clear.  The Medical Act of 1983 mandates the General Medical Council to regulate and oversee the fitness to practise of all medical doctors. Any suspected illegality may prompt that body to issue cease and desist notices, and they may refer the individual to the police which can lead to prosecution.   However, some 400 years ago in England, the situation was rather more vague and its interpretation forms the basis of what has been described as “a landmark of early-modern English law.”

Relatively little is known about the life of the doctor at the centre of this case, but Thomas Bonham was born about 1564 and studied at St John’s College, Cambridge where he graduated MA in 1588 and later MD.   The next we hear of him, he had moved to London, where by the age of 38 he was working as a doctor. 

At the time, the practice of medicine, and specifically the administration of internal remedies, was regulated by the College of Physicians.  The College, which would not become known as the ‘Royal College’ for another 60 years, exclusively licensed London practitioners. Initially, Bonham aligned himself with the Barber-Surgeons’ Company but after their parliamentary petition to become recognised failed in 1605, he had no choice but to turn to the College to seek admission by examination.  They turned him down and told him to return after undertaking further medical studies.  He tried again four months later in spring 1606, but the College was even more intransigent, not only rejecting his application but fining him £5 (around £1,500 today) for persisting in his practice in the interim and threatening him with imprisonment if he failed to pay.

Doubtless disgruntled by the College’s highhandedness, Bonham refused to acknowledge their authority and carried on working. He had washed his hands of the College, but having come to their attention, they were not about to dismiss him so easily.  Aware of his continued unlicensed practice, they issued summonses to appear before them which he ignored, and in autumn 1606 the College imposed another fine, this time of £10 and announced their intention to arrest him.  Bonham appeared before the College asserting his right to continue his practice, claiming they had no authority over medical graduates of Oxford or Cambridge Universities. Thinking that Bonham had come before them either to apologise or be re-examined, the President and Censors were outraged and sent him to prison to be held at their pleasure for contempt. It was a week before Bonham’s lawyer using a writ of habeus corpus was able to have him released.

The lawyer’s success sent a shock wave through the College who had until then been certain that their jurisdiction is such matters would be upheld.  They decided on further action, perhaps thinking to make an example of Bonham, and brought a suit against him in the Court of King’s Bench in 1608.  They charged that he had been practising illicitly for the previous 12 months and demanded a £5 fine for each of those months.  Bonham, wishing to put an end to what he saw as continued harassment, countersued in the Court of Common Pleas a few months later for £100 damages against the College, claiming trespass against his person and wrongful imprisonment.

Thus, the stage was set for two cases in two different courts with Bonham and his right to practise at the centre of both. First the College’s suit was heard.  Their lawyer argued that a Royal Patent issued by Henry VIII and endorsed by subsequent Acts of Parliament gave the College the right to act as they had. The statute, he argued, “intends that none shall practise here but those that are most learned and expert.” The Acts allowed the College the right to punish those “doing and using” physic without its license—illicit practice—and those guilty of “ill using” physic—malpractice. Furthermore, they were also authorised to imprison offenders. The letter of the law was thus clear, but what was open to debate was its intention.  Bonham’s lawyer argued that the law was intended to protect London’s population from poor medical practice and imposters, not bona fide medical graduates. His client, he argued, was one of the “grave and learned” men the Acts were designed to preserve and promote.

Despite these pleas, the Chief Justice in the Court of King’s Bench handed down his verdict in early 1609 finding Bonham guilty of illicit practice and fined him £60.  Unable to pay, Bonham again found himself in prison where he would languish for the next year awaiting the outcome of his countersuit.

Sir Edward Coke, the Chief Justice of the Court of Common Pleas which heard that suit, led a narrow majority that found in favour of Bonham, and he was released.  It was Coke’s ruling that has identified this case for many as a legal landmark. He stated, when considering the Acts of Parliament cited by the College’s lawyer as justifying its actions that,

“the common law will control Acts of Parliament, and sometimes adjudge them to be utterly void; for when an Act of Parliament is against common right and reason, or repugnant, or impossible to be performed, the common law will control it and adjudge such Act to be void.”

For many, this is seen as a challenge to the sovereignty of parliament, and an early salvo fired in favour of judicial review of statute legislation.  Coke’s words are bold even to modern ears and have been used by many in subsequent generations to justify secession from authority and even revolution.  Others have interpreted the ruling in a more restrained way, seeing no such precedents, arguing that Coke’s ruling was in no way radical but entirely consistent with the legal mindsets of the time. Whatever Coke’s intention, the ruling has been used, rightly or wrongly, as the catalyst for change. Perhaps, most famously, John Adams, one of the US founding fathers and later second US President, was present in a colonial courtroom in 1761 where Coke’s ruling was cited. He would later state, “Then and there the child Independence was born.”

While this case concerns events more than 400 years ago, it would be a mistake to think the issue at its core is not as relevant today as it was then. In the UK, the nature of our constitution and the supremacy of parliamentary sovereignty has been much debated in recent years.  Issues of devolved administrations, human rights movements and our membership of the wider EU all present significant challenges to the notion of Westminster’s sovereignty.  Indeed, arguments about the erosion of that sovereignty are seen by some as the singular driving force for the UK’s recent departure from the EU.

The Bonham Case remains controversial to this day, with some seeing it as a judicial irrelevance, while others viewing it as one of the foundation stones of modern constitutional thinking.  While most of what is written about the Bonham Case concerns itself with its wider judicial impact, it should not be forgotten that this was a case about one doctor fighting against what he saw as a monolith of false authority.  For some it is the rousing story of a David overcoming a Goliath, while for others it is a story that resonates with questions still asked today about the monopolies that regulate medical practice.

Sources

  • Bonham’s Case, 8 Co. Rep. 107a, 77 Eng. Rep. 638 (C.P. 1610).
  • Cook, H.J.  Am J Legal Hist, 1985; 29: 301-2.
  • Helmholz, R.  J Legal Analysis, Winter 2009.
  • Edwards, R.A. Denning Law Journal. 1996; 63-90.

© Allan Gaw 2022

This article was originally published in the MDDUS online magazine, Insight.

If you want to read more of my writing on the history of medicine, research and law, try these books. All are available on kindle, and if you’re on Kindle Unlimited, they’re free to download.

Teamwork in Research

Good research is all about teamwork.  It is a multi-disciplinary, multi-professional affair. Formulating research questions, drafting protocols, securing funding, gathering data, analysing results — all these essential aspects of research delivery and many others will require you to interact with your colleagues.  As with everything else, there are right ways and wrongs ways to get things done.  As a busy researcher you need to get the most out of any dealings you have with others.  You need to use your time wisely and put your efforts where they will be most effective.

Here in my take on what are the most important things to think about when interacting with your colleagues from other fields and specialities.

1. Don’t underestimate people

This is especially true of people who do jobs you don’t fully understand and whose knowledge and professionalism you will rely on to get the study done. For example, the laboratory staff, the finance officers, the regulators, the librarians, the clinicians are all highly trained professionals, just like you, and they know things and can do things you can’t.  All these people, like you, have key roles to play in the research process and you may have to work with them effectively to ensure the best outcome for your study.

2. Be clear

Often your interactions with colleagues will be about exchanging information.  The clarity of that exchange will usually determine the quality of the outcome.  If it’s hurried or muddled, the results are unlikely to be what you hope and will often involve you starting from scratch. This time round, however, you will have the disadvantage that whoever you have to deal with might have a negative opinion of you because at their last meeting you wasted their time.

3.  Be civil

You catch more flies with honey than vinegar. Occasionally, you will have to deal with people who are defensive or apparently unhelpful.  This is sometimes because they still have a bad taste in their mouths from their last interaction with a researcher, one perhaps that was less than courteous.  Such prejudice is unfair, but you just have to show them that you’re different — be polite, be professional and be appreciative of their help.  And next time you have to interact with them things might be a little easier.

4. Don’t waste people’s time

Be prepared for a meeting or even a phone call, have the facts and figures ready and don’t keep people waiting. Remember, respect is a two-way street.  You can’t expect to be given respect unless you offer it.  Respect means listening to people,  being punctual, being prepared and above all treating people as you would wish to be treated yourself.

5. Keep the big picture in mind

Research can be hard and some days it can seem impossible.  Relying on your own efforts is one thing, but when you have to chase other people to get things done, while juggling a dozen balls in the air, it can seem daunting.  Never forget what the effort is for — remember it’s about pushing forward the boundaries of knowledge and improving everyone’s life.

©️Allan Gaw 2021

If you want to read more of my writing, try these books. All are available on kindle, and if you’re on Kindle Unlimited, they’re free to download.

Doctor, Druid and Advocate of Cremation

On his death bed, the 92-year old William Price was attended by the wife he had married on his 81st birthday when she was 21.  He said, “Bring me champagne,” and these would be the last words of the most flamboyant, unconventional and controversial figure in Welsh medical history.

Price was born in a remote cottage near Caerphilly. His mother was an illiterate maidservant, while his father was an Oxford-educated Church of England priest, who would later suffer from severe mental illness.  Theirs was an unconventional pairing for the time that foreshadowed Price’s own bizarre life.  A native Welsh speaker, he acquired English when he attended school and despite only enjoying three years of formal schooling from age 10, he excelled academically.  At 14, against his father’s wishes, he left to pursue a medical education. He undertook a six-year apprenticeship with a local surgeon, after which he moved to London. There, he gained his membership of the Royal College of Surgeons before returning to Wales as a General Practitioner.

While many claims have been made regarding his medical abilities, what is certain is that he had a thriving practice for much of his life and also held the post of surgeon at a local factory for almost 50 years.  There, he is reputed to have performed the first skin-graft operation on an injured worker. His social conscience and concern for local people also prompted him to establish one of the first Co-Operative shops and what might be regarded as a early version of the National Health Service for his local community. Despite these achievements, it was his growing eccentricity that earned him his place in history.

In the early years, he became politically active, with left-wing leanings that developed into revolutionary activism as a leading member of the Chartist Movement. By 1839, he was supporting his fellow Chartists by obtaining arms for them, which were subsequently used in the abortive Newport Uprising.  Although not directly involved, Price could see the danger he was in and fled to France, disguised as a woman.

His Welsh nationalism had already begun to manifest itself as an interest in the ancient druids and their culture, but this was further fuelled while abroad. He interpreted an exhibit in the Louvre as an ancient Welsh prophesy that spoke directly to him, prompting him to return to Wales to free his people.  He did return and set himself up as the self-proclaimed Archdruid of Wales and founded a cult based on the practice of free love.  At this time, he also adopted what would become his trademark appearance: long white hair and beard, an emerald green suit with scarlet trim and a large fox-fur hat.  His increasingly erratic behaviour might also have prompted numerous law suits against him, but it was his failed business ventures that forced him to flee again to France, this time to escape his debtors.

In his mid-sixties, he returned home to set up another successful practice and in his early eighties married his young wife in a Druidic ceremony.  His first son, born a year later, was named Jesus Christ, but he lived only 5 months.  Price had long felt that burial was a corruption of the earth, so he duly undertook to cremate his own son on a Welsh hilltop.  The ceremony was interrupted and Price found himself in court charged with “a vicious act of blasphemy”.  He successfully argued that although the act was taboo, there was no law against it, and he was released.  The publicity around the case helped the promotion of cremation, and finally the passing of the Cremation Act in 1902.

The next year, his wife gave birth to a second son, whom they also named Jesus Christ, followed by a daughter two years later.

Price’s eccentricities were manifold: some mere foibles; others dangerous.  He was a nudist, vegetarian and opponent of vivisection and marriage.  But he also spoke out against vaccination, refused to treat any patient who smoked and called his fellow doctors “poison-peddlers”.

When he died, he was cremated according to his own instructions, and the ceremony was attended by some 20,000 people.  There was a carnival atmosphere in Llantrisant that day and its twenty or more pubs ran dry during the festivities. A fitting end to a man described by one biographer as “a maverick and a rebel” and who was also undoubtedly a showman who always enjoyed playing to the gallery. However, it is also possible that he was mentally ill.  Whatever the truth, he remains one of the most colourful members of the medical profession to come from Wales.

If you want to read more about the History of Medicine and Research, try these books. All are available on kindle, and if you’re on Kindle Unlimited, they’re free to download.

The Erasure of Memory

Between the daffodils and the last of the crocuses, the sandstone memorials stand slightly stooped with age.  Leaning forwards or to the side they mark the resting places of the long dead, but marking is all they can now do for age has not only wearied them but worn away all trace of their memorial.  Nameless and dateless, these sad stones stand vigil in the church yard of St Mary Magdalen on Oxford’s Magdalen Street.

Forgotten, the dead are erased from their headstones by the elements.  Layer by layer the stones are peeled apart by the same forces of nature that formed them in the first place, long before they ever found their place in a church yard.  Wind and rain and time have done their inevitable work.  For such a brief moment in their geological history these stones carried the name of the person who was once the body buried beneath them, but all too soon they have returned to the anonymity they had known for millennia before and will know for the remaining years to come.  The people beneath them existed for a fraction of the life of their headstones and all trace of them is now gone, even though stone seemed, in comparison to their fragile lives, such a permanent reminder of their existence.

We memorialise to remember.  Those we have lost, we hold in our memories; keeping them alive in our thoughts.  As time passes and the pain of bereavement is blunted, we may be disturbed to realise that some of the details are slipping away.  Like a fading photograph in the sun, the definition goes and the image is softened and finally lost.  Headstones offer loved ones the false reassurance of permanence.  A resting place is marked forever and some of the heavy work of remembrance will be taken from our shoulders. Stone, however, as we can see in this church yard, is only a short-term solution, lasting a few hundred years at most.  But that’s more than enough for most.  Memories die with us and few of us live on in the remembrance of more than one or two generations.

For some, however, the legacy of memory is the hallmark of success.  A life memorialised, or perhaps more importantly, a life’s work remembered, is to some all that really matters.  When we think of the great who have gone before, we sometimes have tangible evidence that they lived and that they breathed the same air as us.  Museums are filled with the paraphernalia of lives gone by—the gloves worn by a princess, the spectacles worn by a scientist, the lock of hair of an author—but these are insignificant in comparison to the thoughts and ideas that these people left behind.  Ideas can, and do, change lives.  They move worlds and shape futures and live on long after the flesh has rotted from our bones and even our headstones have regressed into anonymous slabs.

But for ideas to survive they must be recorded and documented, and the written word has proved more permanent than any stone to pass a memory down through the ages.  We know what philosophers and kings thought because of what they wrote, or what has been written about them.  We know of discoveries ancient and modern because they have been shared in the scientific literature and now sit on our library shelves.  The works of dead scientists are there to be read and climbed upon that we might see just that little bit further than them.  And we know how timeless our human emotions are because they have been written about in much the same ways for thousands of years by countless story tellers. Songs of love and sorrow, joy and heartache, jealously and rage fill the scrolls of ancient sagas just as they do the pages of any Hollywood script today.

The words of all these writers are their headstones, un-weathered by rain, spoken sometimes across centuries, yet still heard, still listened to, still making a difference.

Most of St. Mary Magdalen’s stones are worn and weathered, but one small headstone near the iron railing that encloses the church yard is now completely covered in ivy.  Whether the name is still there beneath this mound of overgrowth is impossible to see.  While it is tempting to part the leaves to reveal who lies beneath, to do so, however, feels unseemly.  This stone is in effect veiled.  Just as the forces of nature have erased the names on the other stones, another force of nature—life itself—has chosen to obscure this one from view.  The dead in St Mary Magdalen’s sleep on anonymous.  Their identities, like ours one day, may be lost, but not necessarily their thoughts.  These can live on in the memory of the written word.

© Allan Gaw 2021

This is taken from my book Tales from an Oxford Bench which is available on kindle where it is free to download if you’re on Kindle Unlimited, and as a paperback from Amazon.



Also available on kindle:What can we learn from the past that may be relevant to modern drug research?

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