UBl 
 
 NIVERSITY OP 
 
 ;AN LMF-eO 
 
 J
 
 UNiyERS:TY,OF CALIFORNIA SAN DIE^ 
 
 „„„„,, .n.n.nJillllillnlll llilllllllilll' 
 
 3 1822 02315 9510 
 
 lOD
 
 SIXTY-FOUR YEARS A DOCTOR
 
 Cfje Pebication, 
 
 To Sir Thomas Clifford Allbutt, K.C.B., St. 
 Radegund's, Chaucer Road, Cambridge, Regius 
 Professor of Physic at the University of Cam- 
 bridge, WHOSE pathway THROUGH LIFE FROM 1836 
 
 to 1922 has been concurrent with my own, 
 this book of reminiscences is dedicated with 
 a feeling of the most profound respect and 
 admiration. 
 
 Charles Brown.
 
 FOREWORD 
 
 " Sixty- four Years a Doctor " is the life history of 
 Sir Charles Brown, F.R.C.P., Honorary M.A. of Cambridge, 
 Honorary Freeman of the Borough of Preston, and one of 
 its oldest and most honoured citizens. Dr. Lapthom Smith's 
 informative book, " How to be Useful and Happy from 
 Sixty to Ninety," contains some instructions that the Author 
 of the following reminiscences had been carrying out with 
 gratifying results long before he became acquainted with 
 the work in question. These reminiscences are the record 
 of a doctor who is now in his eighty-sixth year, and cover 
 one of the most interesting periods in national and local 
 history. They are the intimate personal recollections and 
 reflections of an old Prestonian. They also take the form 
 of a review of the more important social phases of the greater 
 portion of the last and the beginning of the present century, 
 with special reference to the enormous advances made during 
 this period in medical science and in the development of 
 methods for alleviating physical pain and suffering. What 
 profits may accrue from the publication are to be applied 
 for the benefit of the Preston and County Royal Infirmary, 
 with which the Author has been connected since its inception. 
 
 The Publishers.
 
 <rurL-x^
 
 SIXTY-FOUR YEARS 
 A DOCTOR 
 
 REMINISCENCES OF 
 SIR CHARLES BROWN 
 AN OCTOGENARIAN 
 LANCASHIRE DOCTOR 
 
 PRESTON : 
 George Toulmin & Sons, Ltd., 127 Fishergate 
 
 1922
 
 Printed by 
 GEORGE TOULMIN AND SONS 
 LIMITED, AT THE GUARDIAN 
 PRINTING WORKS, PRESTON
 
 PREFACE. 
 
 I HAVE often been asked to publish some of my Reminis- 
 cences, and I have much pleasure in doing so. I have under- 
 taken the work with three objects in view : — 
 
 1 . To oblige my many kind friends. 
 
 2. To inspire the mind of the public with a feeling of 
 thankfulness for the discovery, between 1836 and 1922, of 
 inventions and appliances which have added so much to the 
 interest and enjoyment of life. 
 
 3. To raise money, by the sale of the book, for the 
 Preston Royal Infirmary, which is in much need of financial 
 assistance. 
 
 R. C. Brown. 
 27 Winckley Square, 
 
 Preston. 
 April. 1922.
 
 CONTENTS 
 
 PAGE 
 
 My Father 1 
 
 My Own Life 6 
 
 Matters of General Interest 13 
 
 Things More Immediately Connected with My 
 Own Profession 28 
 
 Subjects Outside My Own Profession which have 
 Interested Me 53 
 
 Complaints which have an Important Relation to 
 Antitoxic Serum 61 
 
 Diseases which were Previously Included Under 
 Some More General Heading 72 
 
 Operations of Great Benefit to Humanity Under- 
 taken Daily 76 
 
 Instruments Used in the Investigation of Disease 94 
 
 Modern Instruments 97 
 
 Treatment 99 
 
 Diseases of Tropical Climates 113 
 
 Cambridge Research Hospital 113 
 
 Research Laboratories 115 
 
 Reminiscences of Persons 117 
 
 The Royal Albert Institution, Lancaster 179 
 
 Lancashire County Constabulary 180 
 
 Anecdotes 182
 
 SIXTY-FOUR YEARS 
 A DOCTOR 
 
 MY FATHER. 
 
 MY father, Robert Brown, was elected an Honorary 
 Fellow of the Royal College of Surgeons of England 
 in 1852, and was an Alderman of the Borough up 
 to the time of his death, which took place in February, 
 1858, when he was 58 years of age. 
 
 My father practised in Preston from 1822 to 1857. At 
 the age of 14 he was bound an apprentice for seven 
 years to a Surgeon at Skipton in Yorkshire. When he had 
 completed his apprenticeship, he spent one year at St. 
 George's Hospital which was all that was required in those 
 days. After having passed his examinations he became a 
 member of the Royal College of Surgeons of England and 
 a Licentiate of the Society of Apothecaries in 1821. During 
 the early part of his apprenticeship he had to make up bottles 
 of medicine, roll out pills, fill small pots with ointment, and 
 spread blisters and warming plasters. After 17 he had to 
 attend patients who were ill, and he also attended a very 
 large number of what the late Mr. Albert Smith called 
 " Census increasing cases." He was, therefore, what was 
 called an unqualified assistant, but, of course, such a person 
 cannot now be legally employed. As the practice was 
 eminently what is called a country one, most of his 
 visiting was done on horseback, and I have heard 
 him say that he returned from some of his journeys 
 so fatigued that, after unsaddling the faithful animal 
 which had conveyed him on his long journeys, he lay 
 down in the straw and slept in the stall during the re- 
 mainder of the night. Some of the domestic discomforts 
 
 1
 
 2 SIXTY-FOUR YEARS A DOCTOR 
 
 which he experienced formed a striking contrast to the 
 luxuries which I enjoy. He had to wash at a stone pump 
 trough in the stable yard in winter and summer and all 
 weather, whereas I have a beautiful full length marble bath 
 combined with a shower bath supplied with hot and cold 
 water, and a wash hand basin similarly furnished. 
 
 The stirring times through which we are passing throw 
 our thoughts back to the days of our grandfathers, when 
 hours were longer and the reward much less than now. Even 
 in domestic service the contrast is very great. I and my 
 two brothers received our ordinary education at the 
 Preston Grammar School, and, until 1848, when my elder 
 brother went to Christ College, Cambridge, the household 
 consisted of my father, mother, two brothers, myself, four 
 sisters, a governess, a nurse, a cook, a parlourmaid, and a 
 housemaid. The cook had to prepare breakfast, dinner, 
 tea and supper for these 14 grown-up persons and children. 
 The parlourmaid had to wait upon all these 14 persons, 
 except the two youngest children and her feUow servants ; 
 she also had to answer the front door bell both during the 
 day and during the night, and the rings of the front door 
 bell were very frequent 70 years ago. The housemaid had, 
 with the assistance of the parlourmaid, to make all the beds 
 and she had also to attend to most of the rooms. All the 
 washing of the household was done by the cook, housemaid, 
 parlourmaid, and nurse. They were called up for the purpose 
 every Monday morning at one o'clock by the night watch- 
 man who patrolled the neighbourhood, and called out the 
 hour and state of the weather ; for example, " Past ten 
 o'clock, fine night " ; " Past two o'clock, wet morning " ; 
 " Past five o'clock, cloudy morning." The rook, housemaid, 
 parlourmaid, and nurse slept in the same bedroom. There 
 was no gas in any of the bedrooms, and such a luxury as a 
 gas fire was unknown. Coals had to be carried from the 
 cellar to all parts of the house where fires were required. 
 The grates were not so near the floor as they are now, and, 
 instead of the tiled hearth of the present day, there was a 
 stone flag which had to be washed and whitened with pipe
 
 SIXTY-FOUR YEARS A DOCTOR ^ 
 
 clay. The floors of the bedroom were covered with carpet, 
 not with hnoleum, which is much easier to clean and to keep 
 clean. The servants had to clean the outside as well as the 
 inside of the windows. There were no window cleaning 
 companies in those days — 70 years ago. 
 
 The standard of wages was evidently a very low one. 
 The governess, an educated lady, had £20 a year ; the cook, 
 £12; the housemaid, £11 ; the parlourmaid, £10; and the 
 nurse, £8. The coachman, a married man with several 
 children, had 14s. a week, and a bonus of £2 on Christmas 
 Day. The standard wage of the men who drove carts for 
 the coal merchants was 15s. a week, even so late as 1860. 
 The coachman had the care of three horses — " Lop," " Dick " 
 and " Corinthian," and he had to go out when required 
 during the night, as well as during the day. There were 
 no livery stables to supply such a luxury as a cab. It was 
 the custom to " chp " the horses in the autumn, and instead 
 of this being done by a mechanical cutter designed for the 
 purpose, it was done with a comb and pair of scissors, and 
 the horse was afterwards singed with naphtha. My father 
 at first rode in a two wheeled gig during fine weather, and 
 in a covered four-wheeled carriage when it was wet, but as 
 there was danger of the horse coming down and breaking 
 the shafts of the gig, injuring its knees, and throwing my 
 father and the coachman on to its back, a four wheeled open 
 carriage, called a phaeton, was substituted for the gig. Samuel 
 Cave, the coachman, had four sons, Samuel, William, Richard, 
 and John, and three daughters, Anne, Isabella, and Sarah. 
 The four sons became respectively, caretaker of a Bank 
 in London ; an inspector in the Preston Borough PoUce ; 
 a warder in the Preston Prison, or House of Correction as 
 it was then called ; and a sanitary inspector in the service 
 of the Preston Corporation. The three daughters until 
 they married were powerloom weavers at the works of the 
 great firm, Horrockses, Crewdson & Co., Ltd. The coach- 
 man's wife, and my good mother, were examples in character 
 generally, and household management in particular. 
 
 I have in my possession the housekeeping books in
 
 4 SIXTY-FOUR YEARS A DOCTOR 
 
 which are recorded the weekly and yearly cost of fuel, food, 
 clothing, education and other necessaries from 1832, four 
 years before I was born. Since my sister died in 1904, at 
 the age of 70, I have kept the accounts up-to-date. I have 
 selected the year 1848 as my starting point in giving these 
 particulars because it is the one when the members of the 
 household were reduced from 14 to 13 by the removal of 
 my elder brother to Christ College, Cambridge. 
 
 Housekeeping Bills in 1848. 
 
 Comparison between the cost of living to-day and in 
 the year before the war are perhaps too discouraging to be 
 of general interest, and only too readily available to those 
 who keep household accounts. 
 
 The housekeeper's bill for the year (not including rent, 
 rates, taxes, or fuel and lighting), amounted to ;^139 14s. 3|d. 
 
 The various items set out in detail show nothing of the 
 cost per pound of the various commodities, but, bearing in 
 mind that each article was provided in quantities ample for 
 the needs of 14 persons for 52 weeks, the amounts are amaz- 
 ingly small. Bread was home-baked, of course, as the 
 following items show : — Flour, ;^14 13s. ; barm, 12s. 3|d. ; 
 baking, lis. 7|d. (less than 6s. per week for 14 people). 
 
 Other items tell their own eloquent story, such as 
 butcher, ^^38 4s. Id. ; butter, £13 18s. 4|d. ; cheese, £2 9s. Id. 
 eggs, 13 12s. 2d. ; fish, £6 17s. lid. ; groceries, £8 Os. OJd. 
 milk. £12 2s. 2d. ; poultry, £5 14s. lOd. ; tea, £6 7s. 3d. 
 coffee, £4 9s. 5d. ; fruit, £Q 17s. lid. ; meal, 15s. 6d. ; vege- 
 tables, £4 10s. 3|d. A final item which rounds off the whole 
 bill, and will find a parallel in house-keeping accounts in all 
 ages, is sundries, £10 Os. 6d. 
 
 In 1845 my father was the secretary of a committee 
 
 appointed to promote the establishment of a Hospital or 
 
 Infirmary for Preston and neighbourhood. A meeting was 
 
 held in the Council Chamber. The following circular was 
 
 issued : — 
 
 Sir, 
 
 I am desired by his Worship the Mayor and the Provisional Com- 
 mittee respectfully to solicit your pecuniary assistance and co-
 
 SIXTY-FOUR YEARS A DOCTOR 5 
 
 operation to accomplish the erection of a Hospital or Infirmary for 
 the benefit of the Sick Poor of Preston and the neighbourhood. 
 
 Your obedient Servant, 
 
 ROBERT BROWN, 
 Winckley Square, Preston. Secretary. 
 
 New Hospital or Infirmary. 
 
 At a meeting of the friends and promoters of the establishment 
 of a Hospital or Infirmary for Preston and the neighbourhood, held 
 in the Council Chamber, Town Hall, Preston, on Wednesday, Novem- 
 ber 5th, 1845. 
 
 John Paley, Junr., Esq., in the Chair. 
 
 On the motion of Robert W. Hopkins, Esq. 
 Seconded by R. Newsham, Esq. 
 It was resolved : — 
 
 1. That it is the opinion of this Meeting that an Infirmary or 
 Hospital, for the reception and relief of the Sick Poor, would be highly 
 beneficial to the town and neighbourhood of Preston. 
 
 On the motion of Charles Swainson, Esq. 
 Seconded by W. Marshall, Esq. 
 It was resolved : — 
 
 2. That, convinced of the advantages that would result from 
 such an establishment, the gentlemen present deem it eminently 
 entitled to their patronage and support, and will use their best 
 endeavours to promote its erection. 
 
 On the motion of Thomas Miller, Esq. 
 Seconded by Thomas German, Esq. 
 It was resolved : — 
 
 3. That the following gentlemen be appointed a Provisional 
 Committee, with power to add to their number, to forward the business 
 and to receive the Donations and Subscriptions : — The Mayor, the 
 Rev. J. Owen Parr, the Rev. J. Clay, the Magistrates of the Borough, 
 and County Magistrates residing in and near the town, John Addison, 
 R. W. Hopkins, T. Petty, T. Miller, Thomas Walmsley, John Horrocks, 
 Paul Catterall, John Catterall, James German, E. C. Gorst, J. Rofe, 
 Chas. Swainson, W. Howitt, R. Brown, and J. H. Norris, M.D., 
 Esquires. 
 
 On the motion of Rev. J. Owen Parr, Vicar. 
 Seconded by Peter Haydock, Esq. 
 It was resolved : — 
 
 4. That in the event of obtaining adequate funds for effecting 
 the erection of such an Infirmary, &c., such Committee be further 
 empowered to make arrangements respecting the site and plan of the 
 building, and all other particulars which to them shall seem expedient 
 for promoting the general object of the Charity, and completing its 
 establishment ; and that such arrangements be then submitted to a 
 General Meeting for the approval of the contributors and subscribers. 
 
 The Mayor having quitted the Chair, it was moved by Charles 
 Swainson, Esq., and seconded by John Winstanley, Esq., and carried 
 unanimously : — 
 
 That the best thanks be given to his Worship the Mayor, for his 
 ability in conducting the business of the meeting. 
 
 ROBERT BROWN, 
 Preston, November 10th, 1845. Secretary.
 
 MY OWN LIFE. 
 
 I WAS born at 27, Winckley Square, Preston, on 
 October 2, 1836, and, with the exception of an 
 absence of ten years — 1855 to 1865 — I have lived in 
 it for 75 years. 
 
 I was educated at the Preston Grammar School, under 
 the Rev. George Nun Smith and the Rev. Edwin Smith, 
 from 1845 to 1853. From 1853 to 1855 I was a medical 
 pupil of Mr. Thomas Dixon, who lived at the Fishergate 
 corner of Fox Street, and I went with him daily to the Preston 
 Prison, of which he was the Visiting Surgeon. I also went 
 every morning to the old Preston Dispensary to attend the 
 practice in the out-patient department. In July, 1853, 
 I passed a preliminary examination in Classics and Mathe- 
 matics at the Apothecaries' Hall, Blackfriars Road, London, 
 and in July, 1855, I was successful in passing the Matricula- 
 tion Examination at the University of London. In October, 
 1855, I commenced my medical curriculum at King's College, 
 London, and remained there until November, 1858, when 
 I passed the examination at the Royal College of Surgeons 
 of England and the Society of Apothecaries, and received 
 my licences to practice. 
 
 My eldest brother, the Rev. James Taylor Brown, was 
 the Vicar of Holy Trinity Church from 1867 until he died 
 in 1875 at the age of 45, leaving a widow and seven children, 
 the eldest of whom was only 12 years of age. An eighth 
 was born a few months after my brother's death, and there- 
 fore a great responsibility was imposed upon me. 
 
 In 1889 a brother-in-law passed away very suddenly, 
 leaving a widow and eight children, many of whom required 
 my assistance. 
 
 When I had completed my medical curriculum at King's 
 College Hospital and obtained my licences to practice, con- 
 ferred by the Royal College of Surgeons and the Society of 
 Apothecaries in November, 1858, I should have preferred 
 
 6
 
 SIXTY-FOUR YEARS A DOCTOR 7 
 
 to remain in London in order to be the unsalaried House 
 Surgeon and House Physician at the Hospital, and to obtain 
 some of the higher degrees in medicine at the University 
 of London, at which I had already passed the Matriculation 
 Examination. In consequence, however, of the death of 
 my father in February, 1858, after a long and expensive 
 illness, I was obliged to try and earn my own living, and as 
 the post of House Surgeon to the old Preston Dispensary 
 in Fishergate, with rooms, coal and gas, but not board, and 
 a salary of £100 a year, was offered to me, I thankfully 
 accepted it. There was abundant variety of practice, but 
 as I had to visit patients in all parts of the town, on foot, 
 the position might be fairly called a hard one. A few weeks 
 after I had commenced my duties, an old Prestonian, whom 
 I knew, addressed me just as I was going in at the front door, 
 and asked me how I liked the appointment. I replied, 
 " Very much, but I find the work rather hard." He then 
 said, " I am glad you are pleased. A young friend of mine 
 held the appointment, and he died of fever in a fortnight." 
 He said " Good-night," abruptly walked away, and left me 
 to reflect on his discouraging remarks. 
 
 The old Preston Dispensary occupied a portion of the 
 space between Lune Street and Fox Street. It subsequently 
 became the site of the Savings Bank, and it is now the office 
 of the Prudential Life Assurance Co. 
 
 I soon began to occupy the little spare time I had in 
 preparing for the higher degrees, and in August, 1859, I 
 passed the first examination for the degree of Bachelor of 
 Medicine at the University of London. Before I could 
 present myself for the second examination for the M.B. 
 degree, an interval of two years was required, and certificates 
 of having attended some more lectures at King's College. 
 I, therefore, obtained permission from the Governors of the 
 Dispensary for eight months' leave of absence, and I provided 
 as a substitute Dr. John Easton, who had been a fellow 
 student at the Hospital. His parents, who lived at 25, Russell 
 Square, had treated me with much kindness and hospitaUty 
 during my medical curriculum, and I was glad to have the
 
 8 SIXTY-FOUR YEARS A DOCTOR 
 
 opportunity of showing a recognition of their goodness to 
 me when his cousin many years afterwards came to be a 
 teacher of music at the High School for Girls in Winckley 
 Square, Preston. 
 
 On my arrival in London in January, 1861, I obtained 
 rooms in Portugal Street, Lincoln's Inn, and made arrange- 
 ments to attend the required lectures — the out patient 
 department at the Royal Ophthalmic Hospital in Moorfields, 
 and the Hospital for Skin Diseases in Blackfriars Road. 
 I subsequently resided for a few weeks at the General 
 Lying-in Hospital, York Road, Lambeth, and lived for 
 six weeks on the Hospital Ship Dreadnought, which was 
 moored in the Thames, off Greenwich. At the end of the 
 eight months I returned to the Preston Dispensary, and 
 worked hard to complete my preparation for the second 
 M.B. examination, which I passed in November, 1861. I 
 soon began to work very hard again for the Fellowship of 
 the Royal College of Surgeons of England, and was successful 
 in passing the examination in November, 1862. I remained 
 at the Dispensary until March 10th, 1863, when I resigned 
 my appointment and went to Edinburgh for a few weeks, 
 
 I next made the Rotunda Hospital, Dublin, my head- 
 quarters for four weeks, and finally returned to Preston in 
 June, 1863. I have been in Preston ever since. 
 
 I returned to Winckley Square, Preston, at the end of 
 May, 1863, and remained here until August the 18th, when 
 I removed to 43, Lune Street, where I commenced private 
 practice in a house which had previously been occupied in 
 succession by Dr. Norris and Dr. Fearnside. I remained 
 there until March, 1865, when I came back to Winckley 
 Square, and I have been here ever since. 
 
 Soon after my return from Dublin I began to prepare 
 for the M.D. examination at the University of London held 
 in November, 1863, and I am sorry to say that I was not 
 successful in passing. The two subjects were Logic and 
 Moral Philosophy and Medicine, and they must be taken 
 together. If a man failed in the Logic and Moral Philosophy 
 paper, however well he satisfied the Examiners in Medicine,
 
 SIXTY-FOUR YEARS A DOCTOR 9 
 
 he was rejected. Nearly half the candidates who were up 
 had the same fate as myself. Two of the questions in Logic 
 and Moral Philosophy were : — 
 
 1. Upon what grounds has it been maintained that all 
 demonstrative science is hypothetical ? 
 
 2. What is meant by the doctrine that time and space 
 are forms of thought ? Give the arguments for and against 
 it. 
 
 After this failure I tried to console myself with the 
 reflection that I had had enough of examinations, but the 
 ambition returned, and I prepared for and passed the 
 examination for the Membership of the Royal College of 
 Physicians in September, 1865. Nine years later I again 
 presented myself for the examination in Logic and Moral 
 Philosophy, which could then be taken alone, but I am sorry 
 to say I was not successful. However I went up again in 
 1876, and triumphed. 
 
 Shortly after I had retired from the post of House 
 Surgeon, in 1863, I was appointed one of the Honorary 
 Medical Officers, and when the Royal Infirmary was opened 
 in 1870, I was transferred to the Staff of that Institution, 
 and I have long been the only survivor of the original members. 
 I have seen no less than 14 of those with whom I have been 
 associated on the Infirmary Staff pass away. 
 
 In July, 1863, I was appointed Certifying Surgeon 
 under the Factory Act ; from 1865 to 1870 I was an Assistant 
 Surgeon in the 3rd Royal Lancashire Militia, when it was 
 under the command of the late Lord Winmarleigh ; in 1870, 
 one of the Honorary Medical Officers of the Preston and 
 County of Lancaster Royal Infirmary ; in 1873, Local 
 Medical Officer to the London and North-Western and 
 Lancashire and Yorkshire Railway Companies ; in 1894, 
 Medical Officer to the Lancashire County Constabulary, 
 In 1893 I was elected Consulting Medical Ofiicer to the Harris 
 Orphanage and Cross School for the Deaf and Dumb. 
 
 In the early part of 1900, when I was 64 years of age, 
 I was again disturbed by a desire to pass the Medical portion 
 of the M.D. examination at the University of London, the
 
 10 SIXTY-FOUR YEARS A DOCTOR 
 
 date of which was fixed for December 1st. I worked hard 
 in preparing for it, and during October I went two or three 
 times a week by the 6-50 a.m. train to Manchester in order 
 to be at the Royal Infirmary by nine o'clock to go round 
 with Dr. Kelynack for the purpose of examining some of 
 Dr. Dreschfeld's most interesting cases. In November I 
 went to stay at the Euston Hotel, London, that I might 
 visit the wards of the Middlesex Hospital with my friend 
 and old fellow student, Dr. William Cayley, one of its Physi- 
 cians. I also had the benefit of examining patients in the 
 North-West London Hospital, under the guidance of Dr. 
 Harry Campbell, one of the Physicians. I am afraid that 
 I made a mistake in working so hard, for I became depressed, 
 and went to the Royal Bath Hotel, Bournemouth, on 
 November 23rd, to obtain a little cheerfulness. I found that 
 my old friend, Dr. Arthur Ransome, of Manchester, was 
 living in Bournemouth, and he took me to inspect a number 
 of Sanatoria for the treatment of Tuberculosis. Now comes 
 the most unpleasant part of my history. I don't think that 
 a combination of all the synonymous words in the Enghsh 
 language which express stupidity would be too severe to 
 censure me with. Although I had put down my name and 
 paid the fee, I took fright and returned to Preston two days 
 before the examination commenced, intending to go up in 
 1901, but I could never muster courage to do so. I have 
 very frequently been troubled since 1900 with the reproaches 
 of conscience for my stupidity. 
 
 I never did wrong, but a something within 
 Admonished and blamed me the while, 
 I never did right, but that something within 
 Approved an allured by its smile. 
 
 I endeavour to overcome the unpleasant reflection by 
 recalling the distinctions which have been already conferred 
 upon me : — 
 
 1. Associate of King's College, London. 
 
 2. Esquire of the Order of St. John of Jerusalem. 
 
 3. Fellowship of the Royal College of Physicians. 
 
 4. Honorary Freedom of the Borough of Preston.
 
 SIXTY-FOUR YEARS A DOCTOR 11 
 
 5. Honorary M.A. Degree of the University of Cam- 
 
 bridge. 
 
 6. Knighthood. 
 
 I ought to mention that when I called to have my name 
 entered on the list of candidates for the examination in 
 Medicine at the University of London, in 1900, I was received 
 with kindness and encouragement by Sir H. F. Heath, who 
 was then Assistant Registrar, but who now occupies a very 
 important position on the Board of Education. It is an 
 interesting coincidence that a few years afterwards I had 
 the opportunity of showing a little attention to his sister-in- 
 law when she came to be a teacher of music at the High 
 School for Girls in Winckley Square, as the successor to 
 Miss Easton, the cousin of Dr. Easton, whom I have already 
 mentioned in connection with the Preston Dispensary. 
 
 When I began to make inquhies a few weeks after the 
 examination in December, 1900, in reference to the character 
 of it, I found that I should have had no difficulty in passing. 
 I may mention also that after the examination for the 
 Membership of the Royal College of Physicians in 1863, 
 I was commended by Sir George Johnson, one of the examiners, 
 for the excellence of my work. 
 
 My second brother, the Rev. Richard Holgate Brown, 
 was Vicar of St. Paul's Church, Staley, near Stalybridge, 
 and an Honorary Canon of Chester Cathedral. He died 
 in 1887 at the age of 55. 
 
 My eldest sister died in June, 1904, at the age of 70. 
 She was unmarried. 
 
 My second sister was married to Mr. Thomas Moss 
 Shuttleworth in 1858, and she died at Bognor in Sussex, 
 in December, 1919. Up to the time of his death in 1889, 
 he was Clerk of Assize for the Northern Circuit, and his son 
 Arthur is an Associate of the Northern Circuit. Another 
 son, Frederick Gregson Shuttleworth, is Organist and Choir- 
 master of St. Mary Abbots, Kensington. He was Assistant 
 Organist to Mr. Henry Bird, and succeeded him after twenty- 
 five years' service. 
 
 My third sister died at the age of 29, and was not married.
 
 12 SIXTY-FOUR YEARS A DOCTOR 
 
 My fourth sister was married in 1864 to Major George 
 Lamont Hobbs, of the 45th Regiment (Sherwood Foresters). 
 He was invalided home from India and died at Netley 
 Hospital. Their son, Major George Lamont Hobbs, 88th 
 Regiment Connaught Rangers, was also invalided home from 
 India and died at the Osborne Convalescent Hospital for 
 Of&cers in the Army and Navy, in the Isle of Wight. My 
 sister has one daughter, and she and her mother live at Bath.
 
 MATTERS OF GENERAL INTEREST. 
 
 RAILWAYS. 
 
 IT has fallen to the lot of comparatively few people to live 
 during 85 years of a century which has been more re- 
 markable than any of its predecessors for advance in Art, 
 Literature, and Science; especially in those branches of Science 
 that have resulted in the discovery of inventions and appli- 
 ances which have added so much to the interest and enjoy- 
 ment of life. Amongst these I may mention railways, street 
 railways, horse-tramcars, omnibuses, electric tramcars, 
 bicycles, tricycles, motor cycles, motor cars, chars-^-bancs, 
 aeroplanes, the electric telegraph, wireless telegraphy, the 
 telephone, the gramophone, the telautograph, the cinemato- 
 graph, the X-rays, shorthand writing, typewriting, photo- 
 graphy, gas fires, gas cooking appliances, and lighting and 
 heating by electricity. Many of these inventions and 
 appliances cannot be too highly appreciated, but they are 
 apt to be underestimated on account of our familiarity with 
 them. It is often an advantage to lose, or be temporarily 
 deprived of, some of the good things which we enjoy in order 
 that we may the more fully realise their value. 
 
 Anyone who has lost or been temporarily deprived of 
 health, the greatest of all blessings, can confirm the truth 
 of this statement. We have all been taught a lesson on this 
 subject by the high price and limited amount of fuel, light, 
 food, and clothing, the inconveniences caused by the railway 
 and coal strike, and by the scarcity or disappearance of 
 domestic servants. 
 
 Railway trains and everything associated with them 
 have interested me from my earliest youth, and it is one of 
 the great pleasures of my life to reflect upon the changes 
 which have occurred in the various appliances and arrange- 
 ments during the period which has intervened between 
 1838, when the Wigan to Preston line was opened, and 1921. 
 I was Local Medical Officer to the London and North- Western 
 
 13
 
 14 SIXTY-FOUR YEARS A DOCTOR 
 
 and Lancashire and Yorkshire Railway Companies from 
 1873 to 1921, and from 1859 to 1873 I was an assistant to 
 the surgeon who previously held the appointment. 
 
 One of the greatest events of the nineteenth century 
 was unquestionably the construction of railways. The 
 Liverpool and Manchester was the first ever used for passenger 
 traffic ; it was opened in 1830. The following were opened 
 at the dates mentioned : London and Birmingham, 1838 ; 
 Liverpool and Preston, 1838 ; Eastern Counties (now the 
 Great Eastern) 1839 ; London and South-Western to 
 Southampton, 1840 ; Great Western, 1841 ; London and 
 Brighton, 1841 ; Edinburgh and Glasgow, 1842 ; and Great 
 Northern, 1850. The Trent Valley Line, by which the 
 journey from London to Stafford was shortened, was opened 
 on June 26th, 1847. Before this passengers from London 
 to Preston were taken round by Coventry, Birmingham 
 and Wolverhampton. The Caledonian (Carlisle to Edin- 
 burgh) was opened in 1848. The Preston to Wigan line 
 was opened in 1838, and that to Lancaster in 1840 ; but the 
 railway from Lancaster to Carlisle was not completed until 
 1846 ; and it was therefore in 1846 that communication 
 between London and Carlisle, by what is known as the 
 Western Route, was established. 
 
 At the time of my birth in 1836, there was not a single 
 railway train running into or out of Preston. The first line 
 available for the use of the public was that from Preston 
 to Wigan, and it was opened in 1838. At a time when 
 Blackpool occupies such a prominent position in the estima- 
 tion of the pubHc it is interesting to recall a few incidents 
 in its early history. The railway to Fleetwood was opened 
 in 1840, but the branches to Lytham and Blackpool were 
 not available until 1846. In an edition of Bradshaw's 
 Railway Guide for 1844, which I have the good fortune to 
 possess, there is an intimation that passengers for Lytham 
 and Blackpool must leave the railway carriage at Kirkham 
 and Poulton respectively, and that they would be conveyed 
 to their destinations in omnibuses which met every train. 
 As there were only three trains daily to Fleetwood, and they
 
 SIXTY-FOUR YEARS A DOCTOR 15 
 
 ran at 10 a.m., 4-15 p.m. and 7 p.m., an idea may be formed 
 of what a small number of people went to Blackpool in 1844. 
 A short time ago, I read a paragraph in one of the newspapers 
 which said that on a Bank Holiday, or some other special 
 occasion, such as an Aviation Meeting, it is not unusual 
 for the London and North-Western and Lancashire and 
 Yorkshire Railway Companies to convey 100,000 people 
 into Blackpool within a few hours. 
 
 The third-class carriages, as I remember them at first, 
 were entirely open ; they had neither roofs, windows, nor 
 seats, and were called " stand-ups." The second-class 
 carriages had roofs, but so close to the head that a tall man 
 could not stand erect. The first-class carriages were 
 painted in various colours, and had names on the outside, 
 and, therefore, somewhat resembled the old horse-drawn 
 coaches and were modelled on the old coach pattern. 
 
 Carriages are now almost, if not more than, treble the 
 weight they were ; their present weight, without passengers, 
 is about 30 tons each ; and their wheels, like those of the 
 engine, are steel tyred. The carriages of the present day 
 are not only much more commodious and comfortable than 
 those of fifty years ago, but many of them are really 
 luxurious. The third-class carriages on the London and 
 North-Western Railway are superior to those which were 
 provided for first-class passengers at the middle of the last 
 centmry. It is now an everyday occm-rence for many persons 
 to breakfast, lunch, dine, and sleep in the train, and thus 
 reduce the time occupied in travelling a long distance to 
 a minimum. Lavatory carriages are freely supplied, and in 
 the event of an urgent necessity for stopping the train, 
 this can easily be accomplished by pulling a brass chain 
 which passes through all the carriages, partially applies the 
 continuous brake, and so attracts the attention of the driver 
 and guard, who, at the safest available point, brings the 
 train to a standstill. 
 
 For many years after the London and Birmingham line 
 was opened, the luggage of passengers was carried on the 
 top of the first-class carriages, and it was covered with
 
 16 SIXTY-FOUR YEARS A DOCTOR 
 
 waterproof sheeting. A porter had to climb on to the roof 
 of the carriage, and sUde the luggage down an inclined plane, 
 which was attached by hooks to a rail on the side of the 
 roof at the upper end, and rested on the ground at the lower. 
 Confusion and delay often arose during the identification of 
 a passenger's luggage. 
 
 In the earlier days of railway travelling the guard rode 
 outside on a small unprotected seat at one end of the roof. 
 The brakes were worked from the roof of the carriages, and 
 the guard applied the brake by turning on a hand-screw. 
 Guards are now provided with well-lighted, covered luggage 
 vans, which have padded seats, and apparatus for warming 
 food whilst travelling. I remember that about 1850 or 
 1851, luggage trains travelling between Preston and Carlisle 
 had three guards — the head goods guard, or brakesman as 
 he was also called, and two assistants. The first rode in a 
 covered van at the end of the train, and was provided at 
 that time, or shortly afterwards, with a stove. The two 
 assistants had to ride on the open waggons without any 
 protection but an overcoat ; and on a frosty night, or when 
 it was raining or blowing or snowing, their exposed position 
 must have been very trying. There are now no assistant 
 brakesmen. When the wooden brake was applied a smell 
 of burning wood was often experienced by passengers, and 
 I remember that on one occasion a gentleman " snifhng up " 
 remarked : " Pyroligneous acid." " Nothing of the sort," 
 repUed another passenger, "it's the brake." 
 
 When I see the enormous locomotive engines which 
 draw the trains nowadays, I think of the time when they 
 were less than half the size of those now running. 
 
 Moreover, they were so deficient in power that when 
 a train was heavier than usual they had a difficulty in 
 starting. Under these circumstances I have seen the 
 porters called upon to push at the sides of the train to help 
 the engine to move. On a branch line which established 
 a communication between Preston and Longridge, it occa- 
 sionally happened that at one of the intermediate stations 
 the passengers were also requested to get out and push.
 
 SIXTY-FOUR YEARS A DOCTOR 17 
 
 The new engines now running are about 1,005 horse 
 power, and with the tender weigh about 102 tons 15 cwts. 
 The old ones running about 40 years ago were about 300 
 horse power each, and with the tender weighed about 15 tons. 
 The tenders of the old engines were able to hold about 
 500 gallons of water ; those now in use will contain 3,000 
 gallons. The consumption of coal, in the earlier engines, 
 was about 221b. per mile ; in the modern ones it is about 
 501b. per mile, the amount varying with the weight of the 
 trains which have to be drawn. 
 
 Engines with express trains used to run about 30 miles 
 an hour. It took them three hours to go from Preston 
 to Carlisle (90 miles). Now the express trains, leaving 
 Preston at 10-55 a.m. and 1-50 p.m., accomplish the journey 
 in 1 hour and 42 minutes. Engines, whilst going at full 
 speed, gain half an hour or more on the road through taking 
 up water from one or more long troughs laid between the 
 rails at certain parts of the route, a pipe under the tender 
 is lowered into the water as it is passed over. The old 
 engines had to stop three times on the journey to Carlisle 
 for water, and the time lost in slackening, stopping, and 
 starting amounted in each instance to about 10 minutes. 
 
 The diameter of the driving wheels of many of the 
 present engines is 6ft. 6in., about a foot more than that of 
 the old engines. Two standards, 6ft. with six wheels 
 coupled used where the gradients are severe, and 6ft. 6in. 
 with four wheels coupled, better adapted for the more level 
 districts. 
 
 The life of a modern engine is about 20 years, and it 
 is computed that in such a period of time it will run 800,000 
 miles, or, say, 40,000 miles a year. 
 
 Brakes were originally of wood ; subsequently in the 
 form of iron blocks worked by friction wheels and chains. 
 Now all trains are supplied with a vacuum brake, which is 
 under the control of the engine driver. 
 
 Engine drivers and firemen in the earliest days of 
 railways had no protection against the severities of the 
 weather, except that afforded by overcoats, mufflers for the
 
 18 SIXTY-FOUR YEARS A DOCTOR 
 
 neck, and the kind of waterproof headgear worn by sailors. 
 Now the portion of the engine, called the footplate, on which 
 they stand, is covered in both at the sides and at the front, 
 where it is glazed with thick glass, and it has a roof also. 
 In hot weather the temperature of the " cab," as it is called, 
 is rather trying, ; but in winter the protection is much 
 appreciated. 
 
 In wet and frosty weather the wheels of the engine 
 are apt to revolve rapidly without moving the train, and in 
 order to prevent this slipping, as it is called, it was usual 
 to sand the rails for a short distance from a station. When 
 I first began to watch railway trains in my early boyhood, 
 the fireman, carrying a shovelful of fine, dry sand, sprinkled 
 it on the rails before the train started. The next method 
 adopted, and it was a very dangerous one, consisted of 
 letting the fireman sit on the buffer plank at the front of the 
 engine and drop sand on the fine from that position. It 
 was considered a great improvement when the sand was 
 stored in a box, placed about midway between the footplate 
 and chimney, and dropped on the line by this receptacle 
 by the fireman who, in order to perform this function, had 
 to walk along the side of the engine to reach the box. 
 The method at present adopted consists in releasing sand 
 from the box by a mechanical appHance which is worked 
 from the footplate, and also by means of steam sanding 
 apparatus ; thus the dangers associated with the earlier 
 methods are avoided. I well remember being called up in 
 the night to assist at the amputation of the front portion 
 of the foot of one of the Crewe apprentices. In walking 
 on the flat ledge, which there is on each side of an engine, 
 to reach the box for the purpose of sanding the rail, he 
 caught his foot between the spokes of the 7ft. single driving 
 wheel, and sustained such a severe injury that it was 
 necessary to amputate part of his foot. 
 
 The platforms were only sHghtly above the level of the 
 railway, so that in climbing into the carriages invaUds or 
 stout people required a stepladder or the assistance of a 
 porter.
 
 SIXTY-FOUR YEARS A DOCTOR 19 
 
 Rails are now made of steel ; they are about 60ft. long 
 and contain 951b. of steel to the yard. Roughly speaking, 
 each length weighs a ton. Originally they were about 
 15ft. in length. 
 
 Chairs, instead of being, as they once were, narrow and 
 about 151b. in weight, are now broad at the base and weigh 
 about 461b. each. 
 
 Fishplates fasten the ends of adjoining rails together, 
 and with the chairs give great steadiness to the rails. 
 
 The signalling was made by the exhibition of red, green, 
 and white flags during the day, and by red, green, and white 
 lights at night. The signalman, when disengaged, retreated 
 into a little sentry-box, from which he emerged when it was 
 necessary to show a flag or lamp, or to move a lever which 
 altered the points. The signal-box, with its multiplicity of 
 levers, is now a prominent object on every railway ; and the 
 ease with which the signals, both near and distant, are 
 controlled, is one of the triumphs of mechanics. Not less 
 so is the communication between the signalmen in the 
 different boxes which has been established by the use of 
 the telephone. 
 
 A great advance was made in connection with railways 
 and the safety of the public, when it was decided to institute 
 a medical examination of all candidates for employment at 
 the earliest convenient opportunity after their names, ages, 
 and other particulars have been ascertained. Up to a certain 
 point the details of the examination are the same for all. 
 Thus they must be free from hernia, varicose veins, varicocele 
 and piles ; the heart, lungs, and other viscera must be 
 healthy ; they must have undergone vaccination, and they 
 must have good eyesight. The following are the instructions 
 issued to the medical officers : — 
 
 No candidate for employment in the company's service in any 
 capacity involving manual labour may be accepted when such candi- 
 date is found by the examining doctor to be suffering from hernia or 
 varicose veins, or other physical defects which would render him 
 prone to sustain injury in the course of his work or to aggravate any 
 injury so received. 
 
 ClassA (Passenger porters, engine drivers and cleaners, platelayers, 
 seamen, or any other occupation which is directly connected with the
 
 20 SIXTY-FOUR YEARS A DOCTOR 
 
 outdoor working of the traffic) : — To be examined for colour-sense 
 by Holmgren's method. Form-vision to be tested by Snellen's types. 
 Each eye must be examined separately, and must have, without 
 glasses, a minimum acuteness of two-thirds of the normal (v. ^'/, 
 Snellen in feet, or | Snellen in metres). Squint or any chronic 
 disease of eyes or eyelids must disqualify. 
 
 Class B (Goods porters, carmen, horse drivers, and kindred duties 
 not directly connected with the out-door working of the line) : — 
 Colour examination not required. Form vision as in Class A. 
 
 Class C (Clerks, time and storekeepers, messengers, and artisans 
 and labourers not included in Classes A and B) : — Candidates in this 
 Class are required to possess such a degree of sight as will fit them, 
 with or without glasses, for ofl&ce work, or for the duties of the various 
 grades mentioned. 
 
 Bradshaw of 1845 gives the following time-table : — 
 
 Preston to Fleetwood : SJ and 11 a.m. and 5.10 p.m. ; and on 
 Monday, Wednesday, Thursday and Saturday at 7^ p.m. 
 
 Fleetwood to JPreston, Liverpool, Manchester, London, &c. : — 
 8i a.m. and 3f p.m. 
 
 SUNDAYS. 
 
 Preston to Fleetwood : — 9 a.m. 
 
 Fleetwood to Preston, Liverpool, Manchester, London, &c. : — 
 4 p.m. 
 
 Bradshaw for 1844 tells us that during the 24 hours 
 five trains ran between Preston and Lancaster. Bradshaw 
 for July, 1910, states that during a corresponding period 
 there are 40. Of these, however, about 10 do not stop at 
 Lancaster, but run through to Carlisle, either direct or with 
 only a few stops. In 1844 there were three trains from 
 Preston to London ; they departed at 2-57 a.m., 9-45 a.m. 
 and 7-28 p.m. and arrived in London at 1-30, 9-0 and 5-32 
 respectively. On Sundays only the mail trains ran, namely, 
 the 2-57 a.m. and the 7-28 p.m. The times of departure 
 from London to Preston were 8-45 a.m., 10 a.m. and 8-30 p.m. 
 Therefore, as will be seen by the following table, the time 
 occupied from London to Preston was about 1 1 hours : — 
 
 2-57 to 1-30=10 hours, 33 minutes. 
 9-45 to 9-0 =11 hours, 15 minutes. 
 7-28 to 5-32=10 hours, 4 minutes. 
 
 Until the Trent Valley line between Stafford and Rugby 
 was opened in 1847, passengers from Preston to London 
 had to travel via Birmingham. 
 
 In July, 1910, about 20 passenger trains were running 
 between Preston and London during the 24 hours ; the 
 quickest of these accomplishes the journey in four hours 
 and eleven minutes.
 
 SIXTY-FOUR YEARS A DOCTOR 21 
 
 I have not been able to ascertain the fares between 
 Preston and London in 1844, but I find that between 
 Liverpool and London they were : " By mail carriages, 
 four inside," 58s. 6d.; and " By mail carriages, six inside," 
 54s. 6d. In 1914 the fares between Preston and London 
 were : — 
 
 , Single. ^ , Return. v 
 
 1st. 2nd. 3rd. Pari. 1st. 2nd. 3rd. Pari. 
 
 29s. 6d. 19s. 2d. ... 17s. 5d. 57s. 6d. 38s. 4d. ... 34s. lOd. 
 
 I will conclude my remarks with amusing incidents 
 which occurred on two short branch lines in the neighbour- 
 hood of Preston : — 
 
 (1) On the Garstang and Knott End Railway the train 
 could be stopped at any point where a passenger, who wished 
 to travel by it, indicated his wish by holding up his hand. 
 One day the wife of a farmer, coming across a field in the 
 direction of the train, was observed by the engine driver 
 to be giving the recognised signal, but when the train came 
 to a standstill, instead of entering it, she simply asked the 
 guard if he could give her change for half a crown. 
 
 (2) On the Preston and Longridge line, shortly after 
 it was opened, a boy who was riding in the train lost his 
 cap. The attention of the guard was attracted by the 
 loud shouting ; the train was stopped, and the cap 
 recovered. 
 
 The following remarkable accident occurred to a Preston 
 engine driver a few days ago : — 
 
 He was in charge of the seven o'clock train from 
 Carlisle to the South, and just after passing Oxenholme, 
 the glass of one of the look-outs was shattered and the 
 driver cut about the head and face. Subsequently the dead 
 body of an owl was picked up in the cab of the engine. The 
 train was travelling at more than 60 miles an hour when 
 it struck the bird, which was probably flying in the opposite 
 direction, and the velocity at the moment of contact was 
 so great that the owl was literally forced through the thick 
 glass of the look-out.
 
 22 SIXTY-FOUR YEARS A DOCTOR 
 
 TRANSPORT. 
 
 I cannot claim to remember the time when people 
 chiefly travelled from place to place on horseback, and 
 when goods were conveyed on what are called pack-horses, 
 but I have lived to see many remarkable changes in the 
 method of travelling. 
 
 I have witnessed the discontinuance of stage coaches 
 and sedan chairs, the disuse of many kinds of horse-drawn 
 carriages, the introduction of bicycles, tricycles, motor cars, 
 chars-a-bancs, electrical tramcars, railway trains travelling at 
 the rate of a mile a minute, and lastly the revival of aerial 
 navigation. The possibilities associated with flying in the 
 air, and the revolutions to which they will probably give 
 rise, are causing much anxiety as well as wonderment as to 
 what may happen. I remember a Hvery stable keeper named 
 Harding, who commenced business in Preston with one horse 
 and one cab ; I observed the business increase until Harding 
 and Co. had 400 horses and innumerable conveyances of 
 all sizes and shapes, and I have lived to see the dissolution 
 of Harding and Co. and the supplanting of the firm by 
 motor car companies. 
 
 I went to Blackpool and Southport (some time between 
 1890 and 1892) to see motor cars in their experimental stage. 
 As in the case of many other objects, their development up 
 to their present point of apparent perfection is startling. 
 Seventy years ago, medical men who could afford a carriage 
 of any kind visited their patients in a gig — a Mght carriage 
 with one pair of wheels and drawn by one horse with a seat 
 for two persons side by side. This was succeeded by an 
 open four-wheeled carriage drawn by one or two horses 
 and called a phaeton. Other carriages gradually came into 
 use, of which the following are the principal varieties : — 
 The hansom, a two-wheeled cab with a driver's seat behind ; 
 cab, a covered carriage drawn by one horse ; brougham, 
 a covered carriage drawn by one or two horses and with 
 internal fittings superior to those of the cab. The duobus, 
 a covered carriage on two wheels resembling a cottage piano, 
 the keyboard representing the driver's seat and the interior
 
 SIXTY-FOUR YEARS A DOCTOR 23 
 
 fitted with two seats on which the occupants sat sideways, 
 face to face. 
 
 Sedan chairs derived their name from Sedan, in France, 
 where they were first made. A Sedan chair was a portable 
 chair or covered vehicle borne on poles, carried by two 
 porters, one in front and one behind. The bearers whom I 
 remember were elderly men, and it was a favourite piece of 
 amusement on the part of mischievous boys to prick with 
 a pin the calves of the porter who faced the back of the 
 Sedan chair. There used to be two Sedan chairs in Preston, 
 one Whig and the other Tory, and no Tory lady would have 
 been seen in the Wig Sedan for anything. One of these 
 chairs was kept in a passage between two houses in Winckley 
 Square, now numbered 29 and 30, and only two doors from 
 the house in which I am now living. The other was always 
 to be found, when not in use, in a passage in Winckley Street, 
 between the Lancashire and Yorkshire Bank and Buck and 
 Dickson's ofQce. It is said that Sedan chairs were intro- 
 duced into Preston at the Guild of 1662 by R. Langton, 
 one of the bailiffs. People used to ride in them to Church 
 on Sundays. They were carried in them to balls and private 
 parties, and little children, when they died, were taken in 
 them to churchyards to be buried, the coffin being put 
 through the windows and resting horizontally on the lower 
 parts thereof, while the parents sat within and on each 
 side. 
 
 Bath carriages were first locally brought under the 
 notice of Prestonians on August 25th, 1821. They were 
 like the cabs of which only a few are now to be seen in the 
 town or neighbourhood. 
 
 On June 1st, 1868, the late Mr. W. Harding put upon 
 the streets of Preston the first " Hansom," and the late 
 Dr. Howitt, who died in 1873, was the first person who rode 
 in it. St. Walburgh's Church was built from designs pre- 
 pared by Mr. Hansom, the well-known architect. He also 
 invented the Hansom cab. The beautiful spire of St. 
 Walburgh's, which impresses travellers on the L. and N.-W. 
 and L and Y. Railways, is 314ft. 6in. high.
 
 24 SIXTY-FOUR YEARS A DOCTOR 
 
 POSTAL ARRANGEMENTS AND POLICE. 
 
 Most people from early youth to old age, whatever 
 position in life they occupy, are interested in the arrival of 
 the postman, but the postal arrangements, until the uniform 
 penny rate throughout the Kingdom was adopted in January, 
 1840, four years after my birth, were very different from 
 what they are now. Letter writing was then the luxury 
 of the rich, the cost of postage being prohibitive to the poor. 
 The cost of conveying a letter from London to Edinburgh 
 was then a little more than a shilling, and the receiver of 
 the letter and not the sender had to pay the postage. The 
 charge varied with the weight of the letter and the distance 
 which it had to be forwarded. I remember when there was 
 only one postman in Preston, and his name was Johnson. 
 There are now 138. I remember when the Post Office was 
 a small cottage on the right hand side of Church Street, not 
 far from this side of Manchester Road, and when the post- 
 mistress was Miss Hardman. 
 
 I remember when there were only 10 policemen ; novr 
 there are 120. The Police Station was in Avenham Street, 
 on the left hand side, going from Church Street. 
 
 THE TELEPHONE. 
 The value of the telephone can be best appreciated by 
 supposing the privilege of using it to be withdrawn. The 
 first successful exhibition of the telephone was made in 
 London on July 14th, 1877. The telephone is a very im- 
 portant aid to a medical man in the exercise of his profession. 
 With it he can make many of his appointments both at the 
 hospital and in his private practice, he can give instructions 
 to his house surgeons and others, he can send for a taxi cab, 
 and when detained at an operation or by other forms of 
 engagement and unable to return home at the time appointed 
 for his consultation hour, he is able to relieve the anxiety 
 of the patients who are waiting to see him by explaining to 
 his male or female servant the cause of his detention. There 
 is another use of the telephone which I can best illustrate 
 by giving you an account of a case which was recorded in
 
 SIXTY-FOUR YEARS A DOCTOR 25 
 
 some of the newspapers. The child of a young married 
 lady was taken ill in the night with symptoms which she 
 thought were those of croup, a disease of which she had 
 had no previous experience. She at once telephoned to 
 her medical man, and asked him what she ought to do. His 
 reply was, " Hold Johnny up to the telephone and let him 
 cough." When this had been done, the doctor told the 
 lady that Johnny was not suffering from croup, that she 
 might put him in bed again and keep him there until he called 
 to see him in the morning. 
 
 PHOTOGRAPHY. 
 The progress which has been made in connection with 
 the art and practice of photography, and the pleasure which 
 it has given to mankind in aU parts of the world, place it 
 high on the list of inventions and appliances which have 
 added so much to the interest and enjoyment of life. Although 
 for more than 30 years it had been known that pictures 
 might be taken by the rays of the sun acting upon chloride 
 of silver, it was not until 1839 that the process for preventing 
 the pictures from fading away was discovered by Daguerre, 
 a Frenchman. It is instructive to consider how photo- 
 graphy nowadays is associated with the microscope, telescope, 
 magic lantern, X-ray apparatus, the cinematograph, the 
 stereoscope, and other appliances. Remarkable develop- 
 ments have also been made in the application of photography 
 to the purposes of newspaper illustration, the cheapness of 
 the processes of reproduction having given rise to a large 
 number of illustrated periodicals. By the photographic 
 process, too, we are enabled to become the possessor at a 
 small expenditure of facsimile reproductions of famous 
 pictures. As an aid to lectures in various subjects, both 
 scientific and non-scientific, photography is invaluable, and 
 it is daily becoming more so. What a contrast there is 
 between an up-to-date lecture on a visit to America or the 
 Holy Land and such as was delivered 50 years ago ! When 
 we are inviting friends who live at a distance to visit Preston, 
 we can purchase for sixpence or a shilling and send to them
 
 26 SIXTY-FOUR YEARS A DOCTOR 
 
 a book of views taken by photography of the principal streets, 
 buildings and parks of our good old town, and when we go 
 to other countries, cities, and towns, we can bring home with 
 us photographs of what we have seen, and recall many 
 pleasant memories and associations at our will. If an old 
 inhabitant like myself wishes to renew his acquaintance 
 with some of Preston's former citizens, he can go to the Harris 
 Free Library and see photographs of those who were Mayors, 
 Aldermen, and Councillors at the Guilds of 1862, 1882, 
 and 1902. In 1853 I became the proud possessor of a camera. 
 It is interesting to compare the easy way in which a snapshot 
 can now be obtained with the complicated process which 
 was required in 1853. The successive steps at that time 
 were : — (1) Coating a glass plate with collodion ; (2) Immers- 
 ing the plate in a nitrate of silver bath in a dark room ; 
 (3) Exposing the plate in a camera ; (4) Pouring over the 
 plate a developing solution containing sulphate of iron ; 
 
 (5) Immersing it in a solution of hyposulphide of soda ; 
 
 (6) Washing the plate freely with water ; (7) Coating the 
 back of the plate with black varnish. 
 
 FUNERALS AND FUNERAL CARDS. 
 In the early part of my career it was the custom for 
 those invited to a funeral to wear a top hat and a silk hat- 
 band, and shoulder scarf, and, on the Sunday morning 
 following the interment, to appear at church wearing the 
 scarf only. It was also usual to send after the funeral, not 
 only to those who had attended it, but to other friends of 
 the deceased's relatives, a memorial card and a small piece 
 of sponge cake. Most people destroyed the card and gave the 
 cake to some child, but a patient of mine, instead of doing 
 so, pasted each card in a ledger. One day when I caUed to 
 see him, I found him busily engaged with his self-imposed 
 task. On my entering the room, he looked up and said, 
 " Oh ! Is that you ? I have not got you here yet, but I 
 shall be very glad to put your card amongst the others, if 
 I survive you." Medical men and others, when they had 
 made a small collection of these silk articles, returned them
 
 SIXTY-FOUR YEARS A DOCTOR 27 
 
 to the draper who had supplied them, and received 15s. 
 for the pair. As they were generally in an undamaged 
 condition the same two articles appeared at many different 
 funerals, and were a profitable source of revenue for a draper 
 who had a good reputation for his funeral arrangements. 
 The hat-band was a very uncomfortable appliance, for the 
 upper portion of it was as deep as the vertical measurement 
 of the hat, and the lower or streamer portion being down 
 the back, in some cases caused a sensation as if someone 
 was trying to pull the hat off from behind. The scarf rested 
 on the shoulder and hung down the opposite side of the body.
 
 THINGS MORE 
 
 IMMEDIATELY CONNECTED WITH 
 
 MY OWN PROFESSION. 
 
 CHLOROFORM. 
 
 WHEN I became a student at King's College Hospital 
 in 1855, anaesthetics had not been very long in 
 general use. It was only in 1846 that ether 
 began to be employed, and chloroform was used for 
 the first time in a surgical operation in the Edinburgh 
 Royal Infirmary on November 15th, 1847. Sir William 
 Furgusson was then at the height of his fame. He had 
 been appointed one of the surgeons to King's College Hos- 
 pital in 1840, and as chloroform was not used until 1847, 
 he had the experience of performing operations before the 
 introduction of anaesthetics, and comparing it with that of 
 operating under anaesthesia. He could tell us how patients, 
 narcotised by opium or intoxicated with alcohol and uttering 
 piercing screams, and sometimes startling oaths, were 
 forcibly held down by strong assistants. He could contrast 
 the agony, which, before the introduction of ether and 
 chloroform, people had to undergo, both in anticipation 
 and during the performance of surgical operations, with the 
 comparative ease of mind with which such proceedings can 
 now be contemplated. Sir J. Y. Simpson made the first 
 experiment with chloroform in his own house on November 
 4th, 1847. Before chloroform was suggested to him by 
 Waldie, a Liverpool chemist, Simpson personally experi- 
 mented with several chemical liquids in the hope of finding 
 something less disagreeable and persistent in smell than 
 ether. The dream of his life had been to soothe the pain 
 of his patients, and before he realised his dream, he had 
 been almost driven by the painful scenes which he witnessed 
 in the operating theatre, to abandon medicine for the law. 
 The way in which chloroform came into use is very interest- 
 
 28
 
 SIXTY-FOUR YEARS A DOCTOR 29 
 
 ing. It is said that in October, 1847, Waldie, a chemist of 
 Liverpool, was visiting Edinburgh, and in a conversation 
 with Professor Simpson, recommended him to try chloro- 
 form as an anaesthetic, and promised to make and send him 
 some on his return to Liverpool. In a letter written by 
 Professor Simpson to Waldie, he thus describes the event : — 
 
 I am sure you will be delighted to know part of the result of our 
 hasty conversation. I had the chloroform in the house several days 
 before trying it, as after seeing it, such a volatile like liquid, I despaired 
 of it and went on dreaming about others. The first night I took it, 
 Dr. Duncan, Dr. Keith and I all took it simultaneously, and were all 
 under the table in a minute or two. 
 
 Professor Miller, who was a neighbour of Simpson's, 
 used to come every morning to see if the experimenters had 
 survived ! He describes how, after a weary day's labour, 
 Simpson and his assistants sat down and inhaled various 
 drugs out of tumblers, as was their custom. Chloroform 
 was searched for, and found beneath a heap of waste paper, 
 and with each tumbler newly charged, the inhalers resumed 
 their occupation. A moment more all was quiet ; then a 
 crash. On awakening, Simpson's first impression was 
 mental. " This is far better and stronger than ether," he 
 said to himself. His next was that he was prostrate on the 
 floor, and that among the friends about him, there was both 
 confusion and alarm. Dr. Duncan he saw snoring heavily, 
 and Dr. Keith kicking violently at the table above him. 
 They made several more trials of it on that eventful evening, 
 and were so satisfied with the results that the festivities did 
 not terminate until a late hour. In the interval between 
 the 4th and the 15th, Dr. Simpson administered chloroform 
 to about 50 people of whom my friend, the late Dr. Watkins, 
 of Newton-le-Willows, was one. The first child born under 
 the influence of chloroform was the daughter of a medical 
 friend of Simpson's, and she was christened " Anaesthesia," 
 to celebrate the circumstances of her birth. About the 
 7th of November, 1847, it had been arranged that Simpson 
 should administer the new anaesthetic chloroform to a patient 
 who was about to be operated upon, but owing to some 
 circumstances or other, he was unable to be present. The
 
 30 SIXTY-FOUR YEARS A DOCTOR 
 
 operation went on without either him or the anaesthesia, 
 and the patient died on the first incision of the knife. 
 Simpson's absence was providential, for it saved the reputa- 
 tion of chloroform at the outset. 
 
 The first patient ever operated upon under the influence 
 of chloroform was said to be a boy four or five years old, 
 who could only speak Gaelic. He seemed frightened when 
 the sprinkled handkerchief was held before his face, but 
 fell asleep after a few inspirations. The boy was suffering 
 from necrosis of one of the bones of the fore-arm, and Dr. 
 Simpson thus described his experience in this historic case. 
 
 During the operation and the subsequent examination of the 
 wound of the finger, not the slightest evidence of the suffering of pain 
 was given. He still slept on soundly, and was carried back to his 
 ward in that state. Half an hour afterwards he was found in bed 
 like a child newly awakened from a refreshing sleep, with a clear, 
 merry eye and placid expression of countenance, wholly unlike what 
 is found to obtain after ordinary etherisation. 
 
 Another patient, a soldier, was so delighted with the 
 effect, that on awaking after the operation, he is said to have 
 seized the sponge with which the chloroform had been 
 administered, and thrusting it into his mouth, again resumed 
 inhalation more vigorously than ever. 
 
 Simpson was strongly opposed on almost all sides. 
 The public Press charged him with putting a premium on 
 crime by his discoveries. Some said that assassination would 
 become of daily occurrence, and that chloroform would be 
 applied to every criminal purpose. Others affirmed that 
 the inhalation of chloroform produced so strong a resemblance 
 to death that victims would be daily buried alive. The 
 strongest opposition of all came from the religious public, 
 who declared that it was in direct opposition to Scripture, 
 " to avoid one part of the primaeval curse on woman," and 
 from pulpit after pulpit it was denounced as impious. 
 Simpson wrote some strong pamplilets in defence of the 
 blessing which he had brought into use. 
 
 My opponents forget, he said, the twenty-first verse of the second 
 chapter of Genesis. There is the record of the first surgical operation 
 ever performed, and that text proves that the Maker of the Universe, 
 before he took the rib from Adam's side, caused a deep sleep to fall 
 on Adam.
 
 SIXTY-FOUR YEARS A DOCTOR 31 
 
 Simpson was on the winning side, and the greatest 
 battle in science ever fought against human suffering was 
 won. Chloroform was administered to Queen Victoria, 
 practitioner after practitioner adopted it, and Simpson lived 
 to see the blessing acknowledged, and its almost universal 
 use. 
 
 CHLOROFORM. 
 
 The Scotch School maintain that the respiration is the 
 first to fail. Others say that the heart stops first. 
 
 ETHER. 
 
 In November, 1846, a great stir was occasioned by the 
 publication of a letter in the public Press, written from 
 Boston in the United States, regarding the discovery made 
 by Dr. Jackson and Dr. Morton of the beneficial use of ether 
 in surgical operations. The writer of the letter said ; — 
 
 I found on my arrival here, a new thing in the medical world, 
 or rather the application of an old thing, of which I think you will 
 like to hear. It is a mode of rendering patients insensible to the pain 
 of surgical operations by the inhalation of the vapour of the strongest 
 sulphuric ether. They are thrown into a state nearly resembling 
 that of complete intoxication from ardent spirits, or of narcotism 
 from opium. This state continues but a few minutes — five to ten — 
 but during it the patient is insensible to pain. A thigh has been 
 amputated, a breast extirpated, and teeth drawn without the slightest 
 suffering. The number of operations of various kinds, but especially 
 those in dentistry, has been very considerable, and I believe but few 
 persons resist the influence of the agent. 
 
 One of the first to make use of sulphuric ether was 
 Professor J. Y. Simpson, who succeeded in introducing 
 chloroform, a fluid discovered and described at nearly the 
 same time by Liebig and Soubeiran. When Morton, an 
 American surgeon, removed a congenital vascular tumour 
 in the neck from a young man named Abbatt, the operation 
 was completed in about five minutes without a groan from 
 the patient. A Dr. Bigelow, who was present, said to a 
 friend whom he met later in the day, " I have seen some- 
 thing to-day which will go round the world." A private 
 letter from Dr. Bigelow to Dr. Francis Boote, of Gower 
 Street, London, carried the first news to England, and it 
 was communicated to the medical profession in London
 
 32 SIXTY-FOUR YEARS A DOCTOR 
 
 on December 17th, 1846. Two days later, Mr. James 
 Robinson, a dentist, of Gower Street, performed the first 
 dental operation in England, the patient being a Miss Lons- 
 dale, and the operation, the extraction of a firm molar tooth. 
 The name of this celebrated dentist recalls to my mind an 
 incident which occurred to myself. On July 17th, 1853, 
 I travelled to London by a night train to undergo a pre- 
 liminary examination in Classics and Mathematics at the 
 Apothecaries Hall. During the journey I suffered great 
 pain from a decayed molar tooth, and an abscess at its root. 
 Shortly after my arrival I was taken by a surgeon named 
 Thomas Carr Jackson, who lived at the corner of Belgrave 
 Street, King's Cross New Road, now called Euston Road, 
 to the house of the above-mentioned Mr. James Robinson. 
 Mr. Jackson then administered the chloroform, and Mr. 
 Robinson extracted the tooth. I remember that as I was 
 regaining consciousness, Mr. Robinson patted me on the 
 cheek, and said, " Now, Sir, you shall come again another 
 day and have the tooth out," and that after feeling at my 
 gums with the tip of my tongue, I said, " But it is out." 
 I was perfectly unconscious during the extraction, and was 
 able to walk away from Gower Street in a few minutes with- 
 out feeling sickness, dizziness, or any discomfort whatever, 
 and I am thankful to say that I was successful in passing 
 my examination at the Apothecaries Hall. 
 
 On December 21st, 1846, the first surgical operation 
 under ether was performed by Robert Liston, in University 
 College Hospital, London. In the operating theatre, thronged 
 with students, were the late Sir John Erichsen, Lord Lister, 
 who introduced the aseptic method of treatment, and many 
 other famous surgeons. Before the patient was brought 
 in, the Anaesthetist asked the students who crowded the 
 benches in the theatre from floor to ceiling, for some volunteer 
 who would submit himself to be anaesthetised. A young 
 man named Shelbrake, of very powerful build and a good 
 boxer, at once offered to take the new anaesthetic, and came 
 into the arena. He lay on the table, and the Anaesthetist 
 proceeded to administer the ether. After the administration
 
 SIXTY-FOUR YEARS A DOCTOR 33 
 
 had proceeded half a minute, the subject of the experiment 
 suddenly sprang up and felled the Anaesthetist with a blow, 
 and sweeping aside the assistants in the arena, sprang, shout- 
 ing, up the rows or tiers of benches, scattering the students, 
 who fell like sheep before a dog. He fell at the top bench, 
 where he was seized and held down until he regained his 
 senses. The whole scene hardly occupied a minute. Liston's 
 patient was a middle aged man suffering from malignant 
 disease of the skin and tissues of the calf of the leg, for which 
 amputation of the thigh was deemed necessary. He passed 
 easily into complete insensibility, and Liston rapidly removed 
 the thigh, the cutting operation being declared to have 
 lasted only 32 seconds. In a few moments the patient 
 completely recovered consciousness, and apparently did not 
 know that the limb was off. When the towel was removed 
 from the uplifted stump, so that he could see it, he burst 
 into tears and fell back on his pillow. Both patient and 
 surgeon were much affected, and the scene in the theatre 
 was most impressive. All appeared to see what an incalcul- 
 able boon was in store for the human race, and Liston could 
 scarcely command his voice sufficiently to speak. The 
 practice of using ether was soon followed in other hospitals. 
 So rapidly indeed did it extend from one centre to another 
 that by the end of April, 1847, the use of the new anaesthetic 
 may be said to have become general in all operation cases. 
 The value of ether in midwifery practice still remained to 
 be proved, and Sir James Simpson was the first to test its 
 use in this department. 
 
 ETHER. 
 It is generally considered to be a safer anaesthetic than 
 chloroform, in that it is a cardiac stimulant. 
 
 A FEW PARTICULARS ABOUT CRILE'S METHOD. 
 
 Crile is a distinguished American surgeon, of whom 
 Sir B. Moyniham said, in his address to the British Medical 
 Association at Brighton, last year : — 
 
 "To the great discoveries of ether by Morton and of 
 the aseptic method of treatment by Lister, this of Crile
 
 34 SIXTY-FOUR YEARS A DOCTOR 
 
 seems to be the fitting completion. I have used the method 
 for many months, and it has added a pleasure to my work 
 which is really immeasurable." 
 
 The field of operation may be temporarily disconnected 
 from the brain, not only at the time of operation but for 
 periods of from one to five days subsequently. The opera- 
 tion is then conducted in an area which for the time being 
 does not belong to the patient, which he cannot reach by 
 any impulse directed towards it, and which can be dealt 
 with as the surgeon wishes without the patient having any 
 power of receiving impressions from it. The fears which 
 hover round the last hour before an operation are greatly 
 modified by the administration of a small dose of morphine 
 with scopolamine. A happy frame of mind is thereby 
 induced, and very little nitrous oxide gas is required to put 
 the patient soundly to sleep. The memory of the con- 
 veyance of the patient to the operating theatre, and of the 
 administration of the anaesthetic, are often abolished by 
 these measures. 
 
 Sir B. Moyniham has given up using chloroform as 
 an anaesthetic altogether. 
 
 ANAESTHESIA (GENERAL AND LOCAL). 
 A good illustration of the application of science to the 
 development of new methods and the improvement of old 
 ones is found in connection with anaesthesia, for example, 
 in the method of producing insensibility in a small part of 
 the body only, whilst the patient still remains conscious, and 
 also in producing insensibility in a more extensive part of the 
 body as in spinal analgesia. The duration of the insen- 
 sibihty required and the size or extent of the area to be 
 anaesthetised are important considerations in the selection 
 of the most suitable anaesthetising agents. Where the 
 operation is a short one, such as the extraction of a tooth, 
 or the removal of a toe nail, the edge of which is growing 
 into the flesh, or the opening of an abscess, or the forcible 
 bending of a stiff joint, an anaesthetic whose effects are of 
 short duration is of great value. This is also the case when
 
 SIXTY-FOUR YEARS A DOCTOR 35 
 
 the condition of the heart, lungs or kidneys is unsatisfactory, 
 and ether and chloroform are regarded as unsuitable. Other 
 agents besides ether and chloroform, administered by in- 
 halation, are now much used for the production of anaesthesia, 
 especially nitrous oxide gas, A.C.E. mixture, and chloride 
 of ethyl. 
 
 Nitrous Oxide Gas. 
 
 Nitrous oxide gas was suggested by Sir Humphrey 
 Davy in 1799 as a means of rendering patients unconscious 
 during surgical operations, but as then employed it was so 
 uncertain in its action that no great benefit was derived 
 from the knowledge thus acquired, and many years elapsed 
 before it came into extensive use. 
 
 Nitrous oxide is most commonly used in dental work, 
 or for short operations such as bending a stiff joint and 
 breaking down adhesions, the removal of a toe nail which is 
 growing into the flesh, or the opening of an abscess, or the 
 removal of adenoids. It is also sometimes employed in 
 conjunction with ether, the patient first being anaesthetised 
 with gas and the condition maintained by ether. 
 
 A.C.E. Mixture. 
 
 To avoid the depressing effects of chloroform the A.C.E. 
 mixture, consisting of alcohol, chloroform and ether, blended 
 in the proportion of one, two, and three parts respectively, 
 has been used. 
 
 One of my fellow students at King's College, named 
 Charles Moss, after he became a qualified practitioner, 
 devoted himself exclusively to the administration of 
 aucesthetics. In the obituary notice of him which appeared 
 in the British Medical Journal, it was stated that during 
 the whole of his experience he never had a death from 
 anaesthetics, and that he attributed this good fortune to 
 restricting himself entirely to the use of the mixture of 
 alcohol, chloroform and ether, and never employing either 
 chloroform or ether alone. My own experience has been 
 much more limited than that of Charles Moss, but I have 
 found that, although some patients were easily anaesthetised
 
 36 SIXTY-FOUR YEARS A DOCTOR 
 
 with the A.C.E. mixture, there were others who could not 
 be rendered unconscious without the aid of chloroform 
 or ether. 
 
 Ethyl Chloride. 
 
 Ethyl chloride during recent years has been intro- 
 duced as a general anaesthetic with excellent results. It is 
 used for short operations on the mouth or nose, e.g., extrac- 
 tion of teeth or the removal of adenoids, also where a single 
 dose is sufficient for the purpose, such as opening an abscess, 
 reducing fractures and dislocations and for inducing 
 anaesthesia which can be maintained by ether in prolonged 
 operations. Its utility is limited by its extremely volatile 
 nature and by the method which must be employed in its 
 administration. Anaesthesia is indeed very rapid, and 
 recovery is equally rapid, but is rather apt to be followed 
 be sickness and depression. Another use for this drug is 
 as a preliminary to the use of ether or the A.C.E. mixture. 
 
 The agents for producing local anaesthesia are (1) in the 
 case of mucous membrane, such as the interior of the nose, 
 a solution of cocaine applied in a plug of lint or cotton wool ; 
 (2) a freezing mixture of ice and salt ; and (3) spraying with 
 ether or ethyl chloride. 
 
 Local anaesthesia may be produced in several ways : 
 (1) By temporarily paralysing the sensitive nerve endings 
 in the immediate neighbourhood of the part to be operated 
 upon, either by freezing, or the application, or the injection 
 into the surrounding tissues of certain chemical substances 
 which will have that effect (local analgesia) ; (2) By tem- 
 porarily suspending the conductivity of the main nerve 
 trunks supplying the affected areas by injecting into, or 
 around these nerves, chemical substances similar to those 
 used in the former method (spinal and regional analgesia). 
 In neither of these methods is the patient rendered 
 unconscious. 
 
 The chemical substances employed for producing local 
 anaesthesia are, with one exception, all derived from or allied 
 to cocaine. Mucous membrane are readily anaesthetised by 
 applying a five or 10 per cent, solution to them for about
 
 SIXTY-FOUR YEARS A DOCTOR 37 
 
 five or 10 minutes, the insensibility lasting about the same 
 time. 
 
 In dealing with skin or deeper tissues, hypodermic 
 injections of the drug are relied on, the anaesthesia following 
 the course of the peripheral nerves. The action of cocaine 
 is supposed to depend partly on the anaemic condition of 
 the affected tissues induced by arterial contraction, and 
 partly on paralysis of the termination of the sensory nerves. 
 The circulation can also be controlled to some extent by 
 adding a few drops of 1 in 1000 adrenalin solution to each 
 injection of the alkaloid. In making use of cocaine, it must 
 be remembered that cocaine has a distinctly depressing 
 influence upon the heart, and hence more than half a grain 
 should never be employed. Recent experience with the use 
 of cocaine has demonstrated the fact that equally satis- 
 factory results are obtained by injecting larger quantities 
 of much more dilute solutions (one or two per cent.) beneath, 
 as well as all round the site of the operation. (Schlirchs' 
 infiltration method). 
 
 It has been found that many of the allies and derivatives 
 of cocaine are equally efficacious and much less likely to give 
 rise to toxic symptoms. Of these substitutes the best known 
 are eucaine, stovaine and novocain. There are no toxic 
 effects associated with the solution used, and as much as 
 seven ounces may be employed in order to infiltrate the 
 tissues. If allowed to act for 30 or 40 minutes, the parts 
 are found to be not only anaesthetic, but also practically 
 bloodless. Operations of gravity can be performed without 
 pain, including such conditions as strangulated hernia, 
 intestinal obstructions, tracheotomy, thyroidectomy, when a 
 general anaesthetic may be undesirable. Local ancesthesia 
 is also produced by freezing the part, either by the application 
 of ice and salt, or by ether spray, or with ethyl chloride. The 
 rapid evaporation from the surface leads to the freezing of 
 the skin, which becomes of a dead white colour. The 
 anaesthesia produced is of a very fugitive nature, and a 
 certain amount of pain may be associated with the thawing 
 process, but less than that caused by the ether spray. Of
 
 38 SIXTY-FOUR YEARS A DOCTOR 
 
 late years considerable success appears to have attended 
 the use of a mixture of quinine and urea, one per cent, of the 
 combined drugs, which is absolutely non-toxic in any 
 quantity, but is rather apt to produce undue effusion. 
 
 For the production of regional analgesia, must not only 
 the nerve supply of the part be known, but one must also 
 be acquainted with the exact points of emergence of the 
 main nerve trunks from the deep fascia. Spinal analgesia 
 is a condition which results from the introduction within 
 the spinal membranes of some substance which acts upon 
 the nerve centres or roots, and produces insensitiveness to 
 pain in the regions supplied by them. At first cocaine was 
 supplied for this purpose, but the after effects were so 
 troublesome that it had to be given up, and the substance 
 now most generally utilised is stovaine. Analgesia usually 
 develops in from five to 12 minutes, and often shows itself 
 in the perineum before appearing in the feet. Gradually it 
 extends over the whole lower extremity and may reach to 
 the umbilicus or a little higher. It is accompanied by motor 
 paralysis and loss of the reflexes, but the patient may be 
 conscious of ordinary tactile sensations. A certain pro- 
 portion of failures will be noted, and at present it is im- 
 possible to explain their occurrence. When the injection is 
 successful the patient lies quietly during the operation with 
 complete muscular relaxation, and can engage in conversation, 
 smoke a cigarette, or read a newspaper . At the present time 
 the general opinion as to this procedure is that, whilst in 
 suitable cases it may he employed for operations below the 
 umbilicus, when a general ancesthetic is not desirable, yet as 
 a routine method of inducing anaesthesia it has slight advan- 
 tages over the ordinary plan. It is not always certain : 
 the injection is not always painless ; the after-results are 
 sometimes impleasant ; the patient is not protected from 
 nervous shock and apprehension during the operation ; 
 and the question of late nervous sequeloe still remains to be 
 decided. On the whole its employment may be advised 
 when a general anaesthetic is undesirable owing to the 
 condition of the patient's heart, lungs, kidneys, etc., when
 
 SIXTY-FOUR YEARS A DOCTOR 39 
 
 diabetes is present in an aggravated form ; when the surgeon 
 is shorthanded ; and when very complete relaxation is 
 required, as on dealing with fractures. The absence of 
 struggling during and after the administration of a general 
 anaesthetic makes it particularly desirable in the last of 
 these conditions. 
 
 THE ASEPTIC METHOD OF TREATMENT. 
 Lord Lister published his first announcement in the 
 British Medical Journal in 1867, vol. 2, page 246. The 
 title is " On the Antiseptic Principle in the Practice of Sur- 
 gery," and it has undergone many changes since that date, 
 but at the present time it really consists in performing opera- 
 tions and dressing wounds with perfectly clean hands, clean 
 instruments, and clean surroundings. The overwhelming 
 evidence of the incalculable benefits which have resulted 
 to mankind from the practice of it emphasises the assertion 
 that "cleanliness is next to godliness." As a result of the 
 aseptic method of treatment, the number of operations 
 performed for the cure of disease has increased enormously, 
 and the rates of mortality which, in some cases, were scarcely 
 less than fifty per cent., have been reduced to as low a point 
 as one per cent. Many diseases which were previously 
 beyond the reach of treatment are now easily cured by an 
 operation, and, therefore, an inestimable benefit had been 
 conferred on mankind. The use of chloroform and other 
 anaesthetics, by removing the fears and dangers attendant 
 upon pain, led to a great increase in the number and com- 
 plexity of operations, but the mortality following some of 
 them was so great that they had to be abandoned. An 
 operation called " ovariotomy " was one of these, but since 
 the introduction of the antiseptic, or aseptic treatment, as 
 it is now called, it has been undertaken again, and performed 
 with such remarkably successful results as to make it clear 
 that the aseptic method was the one thing needful to complete 
 the usefulness of chloroform. The number of females who 
 have not only been rescued from certain death by the opera- 
 tion of ovariotomy, but have been restored in the course
 
 40 SIXTY-FOUR YEARS A DOCTOR 
 
 of a few weeks to perfect health, is one of the most startHng 
 facts in the history of operative surgery. 
 
 It is very interesting to read some remarks which Sir 
 Frederick Treves made in 1897, and to compare them with 
 the state of affairs at the present time : — 
 
 Sixty years ago the operating room was the dirtiest room in the 
 hospital. The surgeon operated in the dirtiest coat in his profession, 
 a coat stiff with blood and animal filth. He was as proud of his blood- 
 stained rag as a peer of ancient lineage may be of his faded ceremonial 
 robes. 
 
 As most people are now aware an up-to-date operating 
 theatre is an ideal of the most perfect cleanliness. The 
 floor, walls, and roof are covered with glazed tiles, which 
 can be washed with the greatest ease ; there are no angles 
 in which dust can accumulate, and there are the most complete 
 arrangements for washing the hands and sterilising the 
 instruments by boiling them. There is a separate room for 
 the sterilisation of the dressings, the basins, and other 
 utensils, and for boiling the water. There is a room where 
 the patient is anaesthetised by the doctor in the presence of 
 one nurse before being wheeled into the operating theatre. 
 A room is provided in which the surgeons hold their consulta- 
 tions, and the equipment of the lavatories is all that could 
 be desired. On a dull day, or in the night, the theatre is 
 brilliantly illuminated by electricity. The operating table 
 is a model of ingenuity. The operating surgeon and his 
 assistants wear a complete suit of white material, such as 
 drill ; they have caps on their heads, and india-rubber gloves 
 on their hands, and their faces are covered as far as their 
 eyes with a mask of gauze so that the eyes are the only 
 portion of the face which is visible. 
 
 It was at first supposed to be necessary to perform 
 operations in an atmosphere sprayed with carbolic acid, 
 which I can remember caused a very unpleasant tingling 
 in the hands and fingers, and also an uncomfortable feeHng 
 in the respiratory passages. At first the treatment was 
 called antiseptic, because carbolic acid and corrosive subli- 
 mate were largely employed to destroy the vitality of the
 
 SIXTY-FOUR YEARS A DOCTOR 41 
 
 minute micro-organisms supposed to be present, and to 
 prevent their entrance into a wound in an active state. 
 
 PHAGOCYTOSIS. 
 Lord Lister, in his lecture on the steps which had pre- 
 ceded his discovery of the aseptic method of treatment, called 
 attention to what he termed " the romance of phagocytosis." 
 Phagocytosis is derived from two Greek words which mean 
 "eating" and "cells." The term was applied by Metch- 
 nikoff, a Russian Naturalist, to the destruction by the leuco- 
 cytes or white corpuscles of micro-organisms which gain 
 entrance into the blood. Lister pointed out the importance 
 of Metchnikoff's discovery in its relation to lengthening the 
 average duration of human life, to the prevention and 
 weakening of disease, and to diminishing the suffering of 
 mankind. Sir J. Lister recognised in the pugnacious phago- 
 cites invaluable allies in the fight that is being urged 
 against putrefactive microbes. The investigation which 
 led Metchnikoff to the discovery that micro-organisms are 
 destroyed by leucocytes, commenced with the examination 
 under the microscope of one of the lowest forms of animal 
 life called the " amoeba." This is a one-celled body which 
 is found in both fresh and sea water, and is seen to be con- 
 stantly changing its form by protruding and withdrawing 
 finger-like projections with which it is said to capture, en- 
 gulf, and digest bacteria, or micro-organisms present in 
 the water which surrounds it. The white corpuscles or 
 leucocytes of the blood undergo similar changes of form, 
 consisting of protrusions and withdrawals. Metchnikoff 
 found a striking example of phagocytosis when examining 
 a fresh water flea, an animal which is so transparent that 
 the whole phenomena can be observed under the microscope. 
 This fresh water flea is affected by a disease due to a growth 
 in its tissue of a fungus, the spores of which are taken in 
 with the food and penetrate from the alimentary canal into 
 the body cavity. As soon as the spores gain access, the 
 defensive mechanism comes into play, and the spores are 
 surrounded and engulfed by the leucocytes, submitted to
 
 42 SIXTY-FOUR YEARS A DOCTOR 
 
 a process of digestion, and finally destroyed. It is an im- 
 pressive reflection that just as the aseptic method of treat- 
 ment had its origin in Pasteur's discovery, that putrefaction 
 is caused by micro-organisms in the air, so the doctrine of 
 phagocytosis, or the eating or destruction of one set of cells 
 by another set of cells, started with the discovery by Metch- 
 nikoff, the Russian Naturalist, in his examination of water 
 containing an "amoeba," or a water flea. Metchnikoff was 
 led to examine the action of the leucocytes, or wandering 
 cells of the higher animals, and found in them a similar 
 power of engulfing and digesting living organisms. The 
 leucocytes are attracted to the region of the bacteria owing 
 to the fact that the bacteria give off soluble substances for 
 which the leucocytes have an affinity, so that they move 
 into the region in which these substances exist in a high state 
 of concentration. Metchnikoff found that in cases where 
 phagocytosis was active, recovery usually took place, and 
 that when it failed the bacteria continued to grow and death 
 occurred. 
 
 A knowledge of bacteriology has been found of great 
 assistance in the diagnosis and treatment of various forms 
 of throat illness, and in many instances has enabled the 
 doctor to decide where a doubtful case should be placed. 
 Hosts of workers in different countries have demonstrated 
 that infectious diseases are caused by micro-organisms, and 
 that special diseases, for example, tuberculosis and diphtheria, 
 are caused each by its own special micro-organism. They 
 have thus confirmed the induction which had already 
 been made by Pasteur that all infective diseases are caused 
 by micro-organisms. Lord Lister said we cannot look 
 forward with anything like confidence to being able even to 
 see the micro-organism of every infectious disease, and he 
 gives as an illustration the discovery by Pfeiffer, of BerHn, 
 of the micro-organism of influenza, perhaps the most minute 
 of all micro-organisms ever yet detected. The bacillus of 
 anthrax is a giant as compared with this tiny being, and 
 supposing the micro-organism of any infectious fever to be 
 as much smaller than the influenza bacillus as this is less than
 
 SIXTY-FOUR YEARS A DOCTOR 43 
 
 that of anthrax, it is probable that it would never be visible 
 to man. The improvements in the microscope have apparently 
 nearly reached the limit of what is possible, but that micro- 
 organisms are really the cause of all infectious or catching 
 diseases can no longer be doubted. The destruction or 
 taking up of micro-organisms or other solid elements by 
 living cells, as by colourless blood corpuscles, has led to the 
 adoption or advancement of a theory by Metchnikoff and 
 others to explain immunity. It has been found that if 
 micro-organisms such as anthrax bacilli are introduced into 
 an insusceptible animal, some of them will be found within 
 the bodies of the leucocytes, while this does not occur in a 
 susceptible animal. This fact has led to the enunciation of 
 the doctrine that immunity, or insusceptibility, depend on the 
 abiUty or inability respectively of the body cells to destroy 
 micro-organisms. 
 
 I remember the profound sensation which was caused 
 by the announcement in the daily newspapers of Metchnikoff' s 
 theory of phagocytosis, and it is interesting to recall some 
 of the comments : 
 
 Our blood is the battlefield of microbes, and our recovery or our 
 death is the result of the contest between them. 
 
 We have within us minute combative organisms, which have 
 taken their abode in our system as resolute defenders against the 
 hosts of bacteria, which are ceaselessly watching for a breach within 
 the walls of the living citadel. 
 
 The human body would almost seem to be the battle ground of 
 contesting hosts of microscopic organisms. 
 
 It is consoling to know that although we are assailed on all sides 
 by countless microscopic foes, we have within the citadel a lively and 
 industrious defender known as the phagocyte. The phagocytes are 
 devouring cells which attack the microbe of infection and in the same 
 proportion as they are numerous and active is the habihty to disease 
 lessened. 
 
 X-RAYS. 
 The wonderful revelations made by the X-Rays have 
 excited profound interest, and placed the treatment of 
 fractures of the bones and dislocations of the joints on a 
 much more satisfactory basis than it ever was before, for it 
 is now possible to examine them as if the flesh was trans- 
 parent, and not only to examine them, but also to take 
 photographs. The position of bullets, needles, pieces of
 
 44 SIXTY-FOUR YEARS A DOCTOR 
 
 steel, and many other foreign bodies can be ascertained and 
 photographed without resorting to the painful process called 
 probing for them. Some of the diseases of the internal 
 organs can also be elucidated by the X-Rays, and by this 
 agency several diseases of the skin can be cured. Calculi 
 in the kidney, gall and urinary bladders, and obstruction 
 in the stomach and intestinal canal can be inferred from the 
 shadows. I have in my possession a square-shaped piece 
 of steel two and a half inches long and a little over two ounces 
 in weight. At one end it tapers to a blunt point, and at 
 the other it is surmounted by a round, flat, studlike pro- 
 jection. It is probably used for driving nails further home 
 than could be accomplished by the hammer alone. This 
 little article was swallowed by a man, who shortly after the 
 occurrence was admitted into the Preston Infirmary under 
 the care of the late Dr. Dunn, whose widow presented it to 
 me. Dr. Arthur Rayner, the very able director of the X-Ray 
 department at the Preston Infirmary, writes me : — 
 
 I watched this piece of iron on successive days passing up the 
 ascending, across the transverse and down the descending colon, where 
 it was finally safely voided. The patient, who was of somewhat 
 doubtful mental calibre, solemnly assured me that he had bitten the 
 piece of iron during the process of picking his teeth. 
 
 TUBERCLE BACILLUS. 
 In 1882 very valuable information was communicated 
 by Koch in reference to the tubercle bacillus, although its 
 existence had been discovered by Baumgarten a few years 
 previously. The revolution which has been caused by the 
 tubercle bacillus, a micro-organism, the existence of which 
 can only be demonstrated by a staining process and the aid 
 of a very powerful microscope, is something like a romance. 
 Attention has lately been called to the circumstance that 
 the common household fly, which is such an annoyance to 
 housekeepers, and with whose unpleasant tickling we are 
 all so familiar, is a great friend of the tubercle bacillus and 
 is a factor in the determination of tuberculosis, as well as 
 of typhoid fever and other diseases. When we consider 
 that in Lancashire one in every fifteen deaths is due to
 
 SIXTY-FOUR YEARS A DOCTOR 45 
 
 tuberculous disease of the lungs, or what is popularly known 
 as consumption, and that in the year 1919, 155 deaths from 
 consumption occurred in Preston, the necessity for doing 
 everything possible to reduce this high rate of mortality 
 commends itself at once to our judgment. The inestimable 
 value of fresh air and sunlight has always been recognised, 
 but their special importance in relation to tuberculosis is a 
 discovery of comparatively recent years. People's views in 
 reference to the amount of fresh air desirable in a bedroom 
 differ very much. Some are satisfied with sleeping in a room 
 with the windows closed, while others are content with 
 nothing short of the wide open window day and night, 
 winter and summer. The latter is what is aimed at in sana- 
 torium treatment. No amount of wet and cold is allowed 
 to interfere with the arrangement, care being only taken 
 that the patient is shielded as much as possible on the side 
 from which the wind is blowing and that he is kept warm 
 by hot bottles and plenty of clothing. A few years ago 
 I visited a number of sanatoria, and at one of them I asked 
 the Resident Physician if he would kindly favour me with 
 a copy of the prescription for the cough mixture which is 
 given to the patients to relieve one of the most distressing 
 of consumptives' symptoms. He said that cough mixture 
 was not used ; the great remedy was fresh air admitted 
 through the open windows. It was his experience that, 
 although at first the patients complained of the cold air, 
 they soon grumbled when the window was closed. I remem- 
 ber hearing of a commercial traveller who called at an 
 office in Preston looking like a man in an advanced stage 
 of consumption. He appeared a year afterwards the picture 
 of health and scarcely recognisable as the same person. 
 He had not been seated long before he said, "Would you 
 please open the window. I have been in a sanatorium, 
 and cannot breathe comfortably unless the window is open." 
 When asked how his wife liked so much fresh air, he replied 
 that she could not sit in the same room with him. This 
 little story is an illustration of what may happen, but rarely 
 does. The great drawbacks in connection with sanatoria
 
 46 SIXTY-FOUR YEARS A DOCTOR 
 
 are, firstly, the small number of them compared with the 
 number of consumptive patients requiring sanatorium 
 treatment ; secondly, the insufficient time the patient is 
 allowed to remain ; and, thirdly, the want of some place 
 where the patient can reside for a few months before he 
 returns to his own home. At Northwood, in Middlesex, 
 I saw a palatial sanatorium which was erected at a cost 
 of £100,000 by a South African millionaire, a connection by 
 marriage of the late Sir John Gorst. In this institution 
 there are many young women seamstresses and others, 
 who have come from London slirnis and have to return 
 to them in many instances after being only three months 
 under treatment, which is much too short a time for per- 
 manent benefit to be obtained. It is now well known that 
 the cause of consumption, or tuberculosis of the lungs, is 
 the tubercle bacillus, a rod-Uke body, slightly bent and 
 somewhat rounded at both ends. It is so minute that, 
 according to Professor Crookes, 900 could stand upon the 
 point of a small sewing needle. The recognition of the 
 bacillus and its effects constitute one of the greatest marvels 
 of science. The bacillus flourishes in dark, ill-ventilated, 
 warm, moist places. In 1906 the National Assocation for 
 the establishment and maintenance of sanatoria for 
 workers suffering from tuberculosis, estabhshed a sanatorium 
 at Beneden, in Kent. The foundation stone of the building 
 was laid by Princess Christian on July 14th, 1906, and the 
 first patient was admitted on March 4th, 1907. Our beloved 
 Sovereign, King Edward the Seventh, took the chair at a 
 dinner which was held at the Hotel Cecil in aid of the 
 Association, and in proposing the toast of the evening, gave 
 an eloquent and interesting description of the benefits 
 derived from the principles carried out in sanatorium 
 treatment. Since then similar institutions have been 
 established in various parts of the Kingdom, and under the 
 National Insurance Act the number has been considerably 
 increased. It is very interesting to contrast the treatment 
 of pulmonary tuberculosis or consumption, which was 
 practised in the early part of my medical career, with the
 
 SIXTY-FOUR YEARS A DOCTOR 47 
 
 sanatorium form of treatment which is adopted to-day. 
 Patients were carefully guarded from cold, and confined to 
 hot and ill-ventilated rooms and not allowed outside the 
 house except in warm, summer weather. 
 
 Mortality from tuberculosis in the County of Lancashire 
 and Borough of Preston in 1919 : — 
 
 Borough. County. 
 
 Pulmonary Tuberculosis 114 ... 1339 
 
 Tuberculous Meningitis 9 ... 101 
 
 Other Tuberculous Diseases 32 ... 257 
 
 155 ... 1697 
 
 NURSING. 
 The modern system of nursing had its commencement 
 in 1836. The credit of inaugurating the new order of 
 things belongs to Germany, for it was at Kaiserworth that 
 the institute for training deaconesses was founded, and it 
 was at this institute that Florence Nightingale acquired the 
 practical knowledge which enabled her afterwards to turn 
 her remarkable gift of organisation to such brilliant account. 
 During the nineteenth century the quahfications of nurses 
 were greatly raised by the influence of Florence Nightingale, 
 Mrs. Fry, and others, amongst the most important of whom 
 may be numbered Queen Victoria, Queen Alexandria, and 
 our present Queen. In 1877 the St. John Ambulance 
 Association was founded, and in association with it lectures 
 to women on home nursing and hygiene are now given 
 regularly in every part of the country. A few years ago 
 Queen Alexandra, accompanied by her sister, the Dowager 
 Empress of Russia, inspected at Devonshire House over 
 1,100 of the nurses associated with the Queen Victoria 
 Jubilee Institute. They came from all parts of England, 
 Wales, Scotland, and Ireland. Every one of these women 
 had three years of hospital training, and underwent an 
 additional special preparation for work in ill-equipped 
 homes. They spend their days in the homes of the poor.
 
 48 SIXTY-FOUR YEARS A DOCTOR 
 
 going from case to case, dressing, advising, instructing, or 
 contriving some rough and ready device for a back country 
 case where necessity must invent. 
 
 The nurses in the early part of the century were of a 
 type so graphically described by Dickens in Martin Chuzzlewit, 
 Sketches by Boz, and other papers. Most of us remember 
 one of them v/ho was called Mrs. Gamp, and who Dickens 
 told us was a fat old woman with a husky voice ; her face, 
 the nose in particular, was red and swollen, and it was 
 difficult to enjoy her society without being conscious of a 
 smell of spirits. Her usual accompaniments were a species 
 of gig umbrella, a pair of pattens and a snuff-box. Mrs. 
 Gamp lodged at a bird fancier's in Kingsgate Street, High 
 Holborn, next door but one to the celebrated mutton pie 
 shop, and directly opposite the celebrated cats' meat ware- 
 house. At night, during unsuccessful attempts to awaken 
 Mrs. Gamp, the noise would arouse the whole street, and 
 people were to be seen putting their heads out of the windows 
 and inquiring the cause of the noise. 
 
 I remember the time when there was no proper nurse 
 at the Preston Workhouse, but merely an old lady who 
 officiated as matron and nurse. The nursing staff at the 
 present day consists of superintendent nurse, night super- 
 intendent nurse, four charge nurses, and 27 probationer 
 nurses. There is also a separate hospital cook and a nurses' 
 home, with two paid maids. 
 
 AMBULANCE. 
 It is interesting to compare the arrangements for the 
 care and treatment of injured railway servants up to the 
 time when the Preston Royal Infirmary was opened in 1870, 
 with those which existed previous to that date. When a 
 man had been seriously injured, he was carried to one of the 
 11 beer-houses which were to be found at that time in an 
 adjacent thoroughfare called Butler Street, and there he 
 had to remain until he either died or recovered sufficiently 
 to be removed to his home. In the event of an operation, 
 such as amputation of a limb, being required, it had to be
 
 SIXTY-FOUR YEARS A DOCTOR 49 
 
 performed in this most unsuitable place. There were no 
 trained nurses and none of the useful appliances which are 
 provided at an infirmary. I have been present at an opera- 
 tion in the night when the only light was that supplied by 
 a candle. Ten years later, however, the Preston Infirmary 
 was opened, and many of the defects in the care and treat- 
 ment of persons injured on the railway were remedied, but 
 there was still an important requirement. There was no 
 suitable conveyance for the removal to the Infirmary of those 
 who were too seriously injured to ride in a cab, and people 
 walking in the main street of the town had to encounter the 
 unpleasant spectacle of some suffering creature carried 
 shoulder high on a door or shutter by four or six men. 
 A few years later I collected sufficient money to purchase 
 a horse ambulance carriage, and since then one or two of a 
 more up-to-date character have been supplied. In connec- 
 tion with these additional advantages, I must not omit 
 to mention the very valuable services which are rendered 
 by the railway servants who have obtained certificates from 
 the St. John Ambulance Association of fitness to render 
 first-aid. Nowadays, when a man is injured on the railway 
 too seriously for treatment at his own home, he is attended 
 to in the first instance by a member of the Ambulance 
 Corps ; he is next examined by a medical man, and then 
 he is conveyed in the ambulance carriage to the Infirmary, 
 a message having previously been sent through the tele- 
 phone asking the Resident Medical Officer to have a bed 
 and such comfortable appliances as hot bottles ready for 
 him on his arrival. 
 
 THE ORDER OF ST. JOHN OF JERUSALEM. 
 This contains two departments : — 
 
 1. The St. John Ambulance Association. 
 
 2. The St. John Ambulance Brigade. 
 
 The Association is the teaching section. Through its 
 agency, those who desire it obtain first-aid, nursing, and 
 hygiene certificates. The Brigade invites the certificate
 
 50 SIXTY-FOUR YEARS A DOCTOR 
 
 holders to join its Corps Division and Nursing Division. 
 Here they are further trained in ambulance detail, and each 
 year they have to maintain a standard of efficiency by 
 attending so many drills, passing an annual re-examination 
 and parading for inspection, thus demonstrating that their 
 knowledge of first-aid is retained. The St. John Ambulance 
 Brigade has made great progress both at home and overseas, 
 and incidentally, it may be stated here that two reserves, 
 one for the Navy and one for the Army, have been raised 
 by the Brigade. Two thousand of the men who joined the 
 Army Reserve saw service in South Africa, and during the 
 last Great War 22,000 trained men were supplied to the 
 Admiralty and War Ofiice through the medium of these 
 reserves. There was no theatre of war that did not have 
 its quota of St. John men. Apart from the Naval and 
 MiUtary side of the St. John Ambulance Brigade, there is the 
 civil side. During both day and night, first-aid is available 
 to those who unfortunately need it in our streets, offices, 
 mills, factories, and workshops. Much of the transport 
 work connected with the sick and injured is carried out by 
 St. John Ambulance Brigade men. 
 
 AMBULANCE. 
 The St. John Ambulance Association was founded and 
 established by the order of St. John of Jerusalem in 1877. 
 Its objects are : — 
 
 1. The dissemination of instruction in first aid, 
 i.e., the preliminary treatment of the sick and injured, 
 pending the doctor's arrival. 
 
 2. Lectures to women on home nursing and hygiene. 
 
 3. The deposit in appropriate localities of material, 
 such as stretchers, hampers, sphnts, bandages, &c., for 
 use in case of accident. 
 
 4. The development of ambulance corps for the 
 transport of the sick and injured. Upwards of 250 
 administrative " centres " and tens of thousands of 
 " detached classes " have been formed in all parts of 
 the United Kingdom, India, the Colonies, and else-
 
 SIXTY-FOUR YEARS A DOCTOR 51 
 
 where abroad, and over 1,452,427 certificates have been 
 
 awarded. 
 
 The interest in ambulance work in Preston commenced 
 prior to the formation of the centre in 1889. It dates back 
 to 1888, when there was a corps formed, with Dr. W. H. Irvin- 
 Sellers as chief officer. He died very suddenly on November 
 12th, 1921, ten days after opening the new headquarters in 
 Chapel Walks, Preston. He was corps superintendent and 
 corps surgeon, and devoted 33 years to the work of the 
 association. In November, 1889, Mr. Herbert Brierley was 
 appointed hon. secretary, and he is still giving his valuable 
 services. Mr. W. H. Woods is the president of the corps 
 and Dr. Riddell is the chairman of the corps. Mr. James 
 Howarth, New Longton, near Preston, is the corps secre- 
 tary, and Mr. E. F. Millington, Avenham Street, Preston, 
 the corps treasurer. The movement received a noble 
 response from the doctors in Preston. Many applica- 
 tions were made to them to act as instruction surgeons 
 to the classes, and they have rendered valuable services 
 without fee or reward. 
 
 A few years later I gave instructions to railway men in 
 one of the offices on the Preston Station, and I allowed 
 employees at some of the miUs and workshops in the town 
 to attend the classes and to sit at the examination for certifi- 
 cates with the railway men. It would be impossible to 
 describe all the work done by the Ambulance Brigade and 
 Nursing Division. It is only fair, however, to call attention 
 to the assistance given during the war to the Moor Park 
 Hospital by all who passed through the classes. The head 
 of the Hospital, Mrs. Howard (the Matron), is an old St. John 
 worker, and she occupies the post of lady corps superintendent. 
 Mrs. Pickles has also been one of the most enthusiastic 
 workers in connection with the ambulance movement in 
 Preston, and she has rendered invaluable aid in giving 
 instruction to candidates in bandaging and the application 
 of dressings. 
 
 Preston has evidently been recognised by the head- 
 quarters in London as holding a prominent position. Two
 
 52 SIXTY-FOUR YEARS A DOCTOR 
 
 years ago it was arranged, on a scheme known as Lord 
 Ranfurley's, that Preston should be one of the Lancashire 
 centres, and it is known as the North-West Lancashire Centre. 
 Its area extends from Arnside, taking in the coastline and 
 inland places as far as Chorley. Another Lancashire centre 
 is known as the North-East Lancashire Centre, with Accrington 
 as its headquarters, and taking in all the East Lancashire 
 towns bordering on Yorkshire. Classes and examinations 
 are arranged from these centres.
 
 SUBJECTS OUTSIDE MY 
 
 OWN PROFESSION WHICH HAVE 
 
 INTERESTED ME. 
 
 DOMESTIC SCIENCE. 
 
 I BECAME interested in this subject in 1858, when I was 
 appointed House Surgeon to the Preston Dispensary. 1 1 
 was a portion of my duties to attend at their homes those 
 who were too ill to come to the Dispensary to be examined 
 and prescribed for. The patients were those who were not 
 well off enough to pay a private doctor, and not so poor as 
 to require relief from the Poor Law Guardians, and during 
 the Cotton Famine in 1862, many had to avail themselves 
 of the Poor Law arrangements, and many of the patients 
 were of a higher social position than those in the year preced- 
 ing the famine. 
 
 I was very much impressed with the dirty condition 
 of many of the houses, and the absence of ventilation, and 
 also with the want of knowledge of cookery, laundry work, 
 and housewifery. I was less surprised with these circum- 
 stances, however, when, in 1863, 1 was appointed a Certifying 
 Surgeon under the Factory Act, and had to examine " chil- 
 dren " and " young persons " as to their fitness for employ- 
 ment in cotton spinning and weaving factories. Children 
 were those between eight and 13 years of age, and young 
 persons, those between 13 and 16. Children were required 
 to attend school during one half of each day, and were 
 permitted to work during the other half. The children 
 were thus divided into what were called the morning and the 
 afternoon set, and each week they changed places. From 
 1846, when Lord Shaftesbury's Bill came into force, young 
 persons, or full timers, were allowed to work from 6 a.m. to 
 6 p.m., except on Saturday, when they ceased at 12 o'clock. 
 I had also in cases of accidental injury to persons working 
 in the mills, to examine them, describe the nature of the 
 
 53
 
 54 SIXTY-FOUR YEARS A DOCTOR 
 
 injuries, and send a report to the Home Office in London. 
 In visiting these persons who were so seriously injured as to 
 be confined to the house, I had a further opportunity of inspect- 
 ing homes and surroundings. In a report on the health of the 
 town which I wrote in 1861, I called attention to the want of 
 a knowledge of cookery, housewifery, and laundry -work, 
 amongst the females employed in factories and workshops, 
 and I pointed out that they had no opportunity of acquiring 
 a knowledge of these subjects, as from eight to 13 they were 
 half of each day at school or in the factory, or at 13, the whole 
 day from 6 a.m. to 6 p.m. In due course they married, and 
 had to undertake the care of a family without having been 
 taught the necessary duties of a married woman. I asked 
 the question, "Could not this knowledge upon which the 
 comfort and welfare of so many depend be imparted in 
 connection with the school in which the girls are taught 
 reading, writing, and arithmetic ? " When I spoke to 
 education authorities and inspectors of schools on the subject, 
 they shrugged their shoulders and said that there was no 
 time for teaching such subjects. But I am glad that I have 
 been permitted to live long enough to see that in Preston 
 every child attending the elementary schools is compelled 
 to undergo, on attaining the age of eleven, practical instruction 
 in cookery, housewifery, and laundry- work. When I see 
 children in the streets who are only eight years of age, I 
 cannot help feeling that Lord Shaftesbury's Act, which was 
 considered a great improvement on previous Acts, left very 
 much to be desired, and I am thankful that the age has been 
 gradually raised until children under 13 can no longer be 
 employed in factories and workshops. 
 
 A copy of the kind of certificate which I had to fill up 
 in 1863, and many subsequent years, is interesting when 
 compared with the form in use to-day : — 
 No. 396. [COPY] 
 
 FACTORIES REGULATION ACT, 7 Vic. c. 15. 
 Certificate of Age of a Young Person 
 
 To be employed in the factory of Messrs. W. Calvert & Sons, 
 situated in Walton-le-Dale. 
 
 I, Robert Charles Brown, of Preston, duly appointed a Certifying
 
 SIXTY-FOUR YEARS A DOCTOR 55 
 
 Surgeon, do hereby certify That Margaret Eccles, Dr. of James Eccles 
 and Dorothy Eccles, residing in Walton-le-Dale, has been personally 
 examined by me, this Second day of December, One thousand eight 
 hundred and sixty-three ; and that the said Young Person has the 
 ordinary Strength and Appearance of a Young Person of at least 
 THIRTEEN YEARS of Age, and that I believe the real Age of the 
 said Young Person to be at least Thirteen Years ; and that the said 
 Young person is not incapacitated, by Disease or bodily Infirmity, 
 from working daily in the above-named Factory for the time allowed 
 by this Act. 
 
 (Signed) ROBERT CHARLES BROWN, 
 
 Certifying Surgeon. 
 
 I was always a great believer in the desirability and 
 importance of having every female, whatever position in 
 life she occupies, taught practical cookery, housewifery, 
 and laundry work. As a medical man I have seen in many 
 houses, during my long career, very painful illustrations of 
 the want of this knowledge, and never so much as during 
 what may be called the period of the scarcity or disappear- 
 ance of domestic servants. 
 
 In 1906 I promoted the interest of students in training 
 for teachers in domestic science and housewifery, and gave 
 them opportunities of better advancing their studies by 
 allowing them for some years the use of my house. Six or 
 eight of them came three times a week to 27, Winckley 
 Square, accompanied by a teacher. The following interest- 
 ing story is told by Colonel Jolly in his report of the origin 
 and work of the Harris Institute : — 
 
 I was walking down Moor Lane to the Institute one afternoon, 
 and passing an unusually clean-looking house, saw a smart woman of 
 23 or 24 standing at the door. I noticed a kindly smile on her face 
 as I approached, and must confess that I returned what appeared to 
 be a friendly greeting in a similar manner. When she said, "Mr. 
 Jolly, you don't know me." I had to admit that she had the advantage. 
 She said, " Ah, but I know you. I've seen you many a time at the 
 Cookery School, and if there'd been no Cookery School I might not 
 have been here. You know, Mr. Jolly, I went to Smith's Mill, and 
 
 Jack was courting me. He's a joiner.you know, and attended 
 
 Mr. Pye's classes. He told me straight that before he'd wed me I 
 should have to learn to cook and iron. Well, I went to your classes 
 last winter, and now here I am with the nicest house in the row, and 
 proud I am of it, proud of the school, and our Jack's proud of me, 
 and you can tell whoever you like that going to the school in Glover's 
 Court is the best way of getting a decent husband." 
 
 MUSIC. 
 I have always been fond of music from the time when
 
 56 SIXTY-FOUR YEARS A DOCTOR 
 
 I played tunes on the piano, with one finger, up 
 to now, when I find it in my old age a pleasure and 
 a comfort, my appreciation of which I cannot express in 
 words. 
 
 If I had displayed as much energy in practising on the 
 organ and piano in my youth as I have at 85 years of age, 
 I have the vanity to think that I should have been what is 
 caUed an accomplished player, which I certainly am not. 
 I spend at least two hours a day at either the organ or the 
 piano, or both, with a view to preserving the suppleness of 
 my fingers, some of which, as well as the larger joints, are 
 the seat of chronic gouty arthritis. It is probable that if 
 this infirmity had not come upon me, I should not have 
 devoted so much time to music, and therefore I may regard 
 the joint trouble to some extent as a blessing in disguise. 
 Much of the music of the present day gives me little or no 
 pleasure. I like a melody which I can retain in my memory, 
 and although I am prefectly ignorant of the principles of 
 correct harmonious arrangement, I can detect where this 
 is wanting. 
 
 I wish I could describe the thrill which I experienced 
 when I first heard Madam Antoinette Stirling sing Sullivan's 
 " Lost Chord," and the pathetic rendering of Liddle's " Abide 
 with Me," by Madam Clara Butt. 
 
 When I was a medical student at King's College Hospital, 
 from 1855 to 1858, 1 lived not far from the Foundhng Hospital 
 Chapel in Guildford Street, and on most Sundays I attended 
 the service, either in the morning or afternoon, or both. I 
 have no difficulty in playing from memory the 30 chants 
 which I heard during that period. Several of them were 
 composed by the organist, Mr. Willing, between 1855 and 
 1858, and as I sat in the gallery not far from the organ, I 
 have observed him draw the curtain aside and hand a sHp, 
 which I have no doubt contained a new chant, to each of the 
 five professional singers. It was my practice when I returned 
 to my rooms to play the new chant on the piano and, although 
 I made it out entirely by the sound, I found when the music 
 was subsequently published, that my melody and harmony
 
 SIXTY-FOUR YEARS A DOCTOR 57 
 
 were generally correct, although I am entirely ignorant of the 
 rules of harmony. 
 
 I was organist of Holy Trinity Church, Preston, for five 
 years, but the service was a very plain one, consisting only 
 of chants and hymn tunes. It it had been more elaborate, 
 I should not have considered myself competent to undertake 
 it. 
 
 I was President of the Preston Musical Festival Committee 
 for four years and of the Preston Amateur Operatic Society 
 for a similar period, during which the members gave very 
 creditable performances of Gilbert and Sullivan's " Trial by 
 Jury," " The Pirates of Penzance," "Patience," " lolanthe," 
 and " The Mikado." 
 
 I gave an organ to each of the following institutions : — 
 The Preston Royal Infirmary ; The Preston Grammar School ; 
 The Harris Orphanage ; and The Home for the Blind. Until 
 two years ago, I played the organ at the Preston Royal 
 Infirmary every Sunday evening for about an hour, and most 
 of the patients greatly appreciated my services. Many of 
 of them said that it was delightful to be in bed recovering 
 from an illness or the effects of a surgical operation, and 
 hstening to the soothing tones of an organ. I can verify the 
 correctness of what has been said of the beneficial influence 
 of the tones of an organ in the distance, from my own personal 
 experience. After a serious illness which I had in 1883, 
 my friend of many years standing, Mr. James Tomlinson, 
 the Preston Borough Organist, a most accomplished musician 
 and performer on both the organ and piano, used to delight 
 me with selections from the works of Mendelssohn, Haydn, 
 Spohr, Henry Smart, Barnby, E. J. Hopkins, Stainer, Dykes, 
 and other well-known composers. 
 
 It was one of the great pleasures of my life to give an 
 organ to the Preston Grammar School, where I received 
 the whole of my education, except the medical portion of it. 
 I felt that an organ would be an appropriate gift and one 
 which would be much appreciated. An organ has many 
 recommendations. It is an important auxiliary to religious 
 worship, and as the day's work at this school begins with
 
 58 SIXTY-FOUR YEARS A DOCTOR 
 
 prayer and singing, I have the satisfaction of knowing that 
 it has been found a valuable addition to the equipments 
 of the school. Apart from the aid which it gives to religious 
 worship, it will be of great assistance in accompanying the 
 pupils' singing classes, and in emphatically illustrating the 
 difference between a right and a wrong note. Moreover, 
 the organ will be of great service in promoting a taste for 
 organ music and in teaching pupils how to play the king of 
 instruments — a term which has been applied to the organ 
 on account of the number of pipes which are under the con- 
 trol of one performer, and the varieties of tone which can be 
 produced either singly or in combination. The remarks 
 which were made at the opening of the Grammar School 
 organ by Dr. James, Master of St. John's College, Oxford, and 
 formerly Headmaster of Rugby, are worth repeating. He 
 said, " Music teaching was a branch of their school work 
 which was advancing more rapidly of late years than any 
 other. Instrumental, orchestral, vocal, and choral music had 
 all reached a development quite undreamt of when he was at 
 school. The attitude of teachers and boys had completely 
 changed for the better. They got great access to instumental 
 performances, and that on a considerable number of different 
 instruments. All arts had their place in education, especially 
 in a materialistic age like the present, and music was by no 
 means the least of the arts they ought to be teaching their 
 boys." 
 
 Musical competitions are held annually at Blackpool, 
 Morecambe, and other places. They bring to hght those who 
 have good voices and also instrumentalists who would other- 
 wise be unknown, or known only to a few. The competition 
 for a prize is a powerful stimulus to vocalists and instru- 
 mentalists to exercise their best efforts and those who failed 
 to obtain one, reap the advantage of having increased their 
 knowledge of music and their faculty of singing during the 
 work of preparing for the contest. 
 
 The introduction of action songs by children has been 
 a great step in advance and has afforded much pleasure to 
 their parents, and most members who are present at the
 
 SIXTY-FOUR YEARS A DOCTOR 59 
 
 competitions. A great deal of the music which is rehearsed 
 at the local Musical Festivals is more remarkable for the 
 difficulties it presents to the candidates than for the pleasure 
 it gives to the audience. The Blackpool Musical Festival, 
 which takes place annually in October, is now recognised as 
 the most important of the Northern Competitive Festivals, 
 and it draws its supporters from all parts of the Kingdom. 
 The adjudicators for the various Preston Musical Festivals 
 were Dr. W. S. McNaught, Mr. Dan Price, Mr. Harry Evans, 
 Dr. Mann, and Dr. Roland Rogers, with Mr. C. H. Fogg and 
 Mr. J. E. Adkins, the accomplished organist of Preston 
 Parish Church, as assistants. It was a great pleasure to be 
 associated with men so well known in the musical world, 
 and especially with those of them whom I entertained in my 
 own house. 
 
 A very interesting incident occurred to me in connection 
 with the Gilbert and Sullivan operas. In December, 1899, 
 I went to the Preston Theatre to see a D'Oyley Carte Com- 
 pany in " The Sorcerer." A few minutes after the perform- 
 ance had commenced, one of the ladies suddenly collapsed, 
 and would have fallen but for the support of one of the 
 gentlemen. I was requested by the manager to go to the 
 back of the stage, and I found that the lady had a temperature 
 of 104° F., and that she was shivering. Presently a young 
 gentleman appeared who told me that he was an officer in 
 Her Majesty's Navy, and that he was engaged to the young 
 lady. I directed him to go to her rooms and ask her landlady 
 to make a fire in her bedroom and put a hot water bottle in 
 her bed, and when she had arrived there, I let her have a 
 hot-air bath, and she told me that it was the most luxurious 
 method of treatment she had ever experienced. The hot- 
 air is generated by a spirit lamp and contained in a circular 
 tin box, from the top of which a chimney conveys it under 
 the bed clothes, which are sufficiently raised by a bridge 
 made of wicker work. The lady's mother came down from 
 London the next day and remained with her until the end of 
 three weeks, when she had sufficiently recovered to leave 
 Preston. The gentleman, during this time, was a frequent
 
 60 SIXTY-FOUR YEARS A DOCTOR 
 
 visitor to my house. I had a letter from him last year 
 reminding me of my attendance on the lady who shortly 
 afterwards was married to him at a cathedral, by a bishop. 
 His letter also contained the gratifying information that he 
 now occupies a high position in His Majesty's Navy. He 
 was fortunate in securing such a handsome, charming, and 
 highly accomplished lady, and I regarded it a privilege and 
 pleasure to attend her.
 
 COMPLAINTS WHICH 
 
 HAVE AN IMPORTANT RELATION 
 
 TO ANTITOXIC SERUM. 
 
 DIPHTHERIA. 
 
 IN the Lancashire Daily Post of January 11th, 1922, 1 read, 
 " London is at the present moment undergoing a very 
 severe epidemic of diphtheria, the number of patients 
 suffering from this disease who are at present in the Metro- 
 pohtan Asylmn Boards Hospitals constituting a new record. 
 Tnere are now 3,215 cases of diphtheria in the Boards 
 Hospital, as compared with 2,562 and 1,821 on simUar dates 
 in 1921 and 1920." 
 
 Writing in 1871 the late Sir T.Watson said, "I had 
 been for more than a quarter of a century in practice in 
 London before I ever met with a case of diphtheria or scarcely 
 so much as heard of such a disorder." 
 
 In the year 1855 alarming rumours reached this country 
 of its prevalence and fatality at Boulogne. Soon afterwards 
 scattered cases of the disease began to appear among us, 
 and presently so multiplied in number as to constitute a 
 real epidemic. It has never since ceased to be the dread 
 of parents, and I may say of medical men also. 
 
 The bacillus now recognised as the specific cause of the 
 disease was discovered about the year 1884. The discovery 
 of antitoxic serum, which is now recognised as such a valu- 
 able agent in the treatment of diphtheria, was one of the in- 
 direct results of Koch's experiments with tuberculin. 
 
 We learn from the writings of Hippocrates, Galen, 
 Celsus, and others that diphtheria existed in the earliest 
 ages, and it is certain that epidemics of it have occurred at 
 times in various parts of Europe during several centuries. 
 The bacillus may remain alive for weeks, or even months, 
 in fragments of dried membrane. Evidence has been brought 
 forward to show that it may sometimes be transmitted over 
 
 61
 
 62 SIXTY-FOUR YEARS A DOCTOR 
 
 considerable distances of country by the wind. It is probable 
 that the disease is due to something which can fertilise in 
 air and water, and which subsequently taken into the human 
 body can develop the disease in a contagious form. Diphtheria 
 has appeared to be due in some cases to polluted water, and 
 it is certain that it may be transmitted by milk. Recent 
 researches of Klein give circumstantial evidence that cats 
 suffer from a form of diphtheria similar to that which affects 
 human beings. It is therefore possible that cats may have 
 been the originators of epidemics of diphtheria among the 
 human inhabitants of the household to which they belong. 
 Behring's treatment of diphtheria by the subcutaneous 
 injection of antitoxic serum is another striking illustration 
 of the important relation which exists between the exciting 
 cause of disease and the remedies for its prevention and cure. 
 The power of infection in diphtheria is, as a rule, not so great 
 as that of smallpox and scarlet fever, or at any rate diffusion 
 in the air seems to weaken it so that those who catch the 
 disease are usually those who have been in close contact 
 with the patient and have inhaled his breath or the affected 
 atmosphere about him, or have had some of his or her 
 expectoration ejected into the mucous membrane of their 
 own throat. Persons have also contracted the disease by 
 kissing the patient, or by going into the presence of one 
 affected with diphtheria whilst suffering from an abrasion 
 or sore. Medical men have introduced it into their own 
 throats by suction whilst endeavouring to clear an obstructed 
 tracheotomy tube. Diphtheria is said to originate some- 
 times de novo, in connection with bad drains, and in newly 
 inhabited houses which have been built on "made soils." 
 In considering the possibility of its origin de novo, however, 
 we must remember that the bacillus may remain alive for 
 weeks, or even months, in fragments of dried membrane. 
 The way for the diphtheria poison may be prepared by other 
 diseases, such as tonsilitis or quinsy, rendering the throat 
 a vulnerable point, or by diseases which weaken the system 
 and so diminish its power of resistance. According to Sir 
 R. R. Thorn, school attendance is an important factor in
 
 SIXTY-FOUR YEARS A DOCTOR 63 
 
 the propagation of diphtheria. He thinks that the association 
 of a number of children under one roof for several days daily 
 is not only favourable to the transmission of infection, but 
 the children are at an age when they are very likely to take 
 diphtheria on being exposed to it, and at an age when they 
 are very susceptible to the noxious influence of overcrowding 
 and inadequate ventilation. As regards the relation of the 
 bacUlus to the treatment of the disease, the injection of 
 antitoxic serum has now obtained such a firm hold on the 
 confidence of medical men, in consequence of the success 
 which has attended the use of it, that in combination with 
 efficient local treatment, it has superseded every other method 
 which has hitherto been adopted. Now the early injection 
 of antitoxic serum and flushing the throat, and, if necessary, 
 the nasal passages, with some antiseptic and astringent 
 solution, is the treatment adopted. It is claimed for it that 
 it checks the development of the disease, causes the wash- 
 leather like membrane which forms on the throat to separate 
 earlier, diminishes the frequency of the windpipe becoming 
 affected, and reduces the mortality. More careful super- 
 vision of children in public schools, the bacteriological 
 examination of suspected cases, and precautions against 
 the dissemination of the disease are still urgently needed. 
 
 Since the advantages of the antitoxic treatment of 
 diphtheria were disclosed, it has been recommended that 
 immediately upon the diagnosis being known, and even 
 before, if there is a high probability of the suspicion being 
 confirmed by bacteriological examination of a swab from 
 the throat, antitoxic serum should be injected. The serum 
 is prepared by rendering a horse immune by successive 
 injections of increasing quantities of the culture fluid of the 
 diphtheria bacillus, deprived of the organism itself and when the 
 animal is at length completely unsusceptible to the diphthe- 
 ritic poison, the animal is bled, and its blood serum is found 
 to have the power of neutralising the influence of diphtheria 
 cultures injected into animals, and hence it appears that 
 this serum contains a substance (antitoxin) which antagonises 
 the toxin of the diphtheria bacillus.
 
 64 SIXTY-FOUR YEARS A DOCTOR 
 
 TYPHOID FEVER. 
 
 The typhoid bacillus was discovered in 1880. 
 
 It is believed to enter the body with the food or drink, 
 or by inhaling emanations from dust heaps, privies, water 
 closets, drains, and sewers. It is also supposed that the bacilli 
 contained in the foecal discharges which have been allowed 
 to dry on the patient's linen or person, or in receptacles 
 containing the bacilli, are disseminated in the form of dust. 
 Drinking water contaminated by sewage and defective 
 sanitary arrangements are frequent factors in the production 
 of the disease. It is now well known that milk, butter, 
 cream ices, oysters, cultivated in estuaries which receive 
 sewage, water cresses grown in ditches contaminated by 
 sewage, lettuces and other salads watered with polluted 
 water, sometimes spread the disease. 
 
 Dr. Cayley, one of our most eminent authorities on the 
 subject of fever, thinks that articles of food may be con- 
 taminated by flies, to whose feet the typhoid germs may 
 easily adhere. 
 
 Since the bacillus was discovered, an important aid to 
 diagnosis has been given to us by Widal, in what is known 
 as the serum test. It is found that when the blood serum 
 of a typhoid patient is mixed with a cultivation of typhoid 
 bacilli, the latter become motionless. 
 
 The general principles on which typhoid fever is treated 
 to-day differ little from those which were in use 50 years 
 ago. There are two methods, however, which have been 
 introduced since the discovery of the bacillus — the eliminative 
 and the antiseptic. The antiseptic consists in administering 
 remedies to destroy or render inert the typhoid and septic 
 microbes in the intestinal canal. The other, the eliminative, 
 has for its object the elimination by purgatives of the toxins 
 and expulsion of the bacillus. The antiseptic method is 
 useful in checking putrefaction and fermentation in the 
 intestinal canal, but does not destroy the typhoid bacilli 
 which are lodged in the glands and spleen. The eliminative 
 method is not free from danger, as it stimulates an ulcerated 
 bowel to active peristalsis, and as the typhoid baccilli are
 
 SIXTY-FOUR YEARS A DOCTOR 65 
 
 mainly embedded in the tissues and glands, they are not 
 affected by purgatives. There are a few other measures 
 which have an important bearing on the prevention of 
 typhoid fever which were not adopted 50 years ago. I 
 allude to the isolation of patients instead of treating them 
 in the wards of a general hospital, and to the notification of 
 cases to the sanitary authority, and to the disinfection of 
 the urine as well as the foeces. 
 
 The practice of sponging the surface of the body with 
 cold, or tepid water, was in favour 50 years ago, but the 
 custom of placing the patient in a bath containing water at 
 a temperature of 80° Fahr., or lower, for 15 minutes, 
 whenever the thermometer registers above 102° Fahr., is a 
 much more modern one. 
 
 Vaccination, with an emulsion recommended by Sir 
 Almroth Wright and Professor Sempel, is used to render 
 persons exposed to the dangers associated with typhoid free 
 from the risk of contracting the disease. Extensive observa- 
 tions were made on the British Army in India, and during 
 the South African War. The general result is that, on the 
 one hand, protective inoculation diminishes the tendency 
 for the individual to contract typhoid fever, and on the other, 
 if the disease be contracted, the likelihood of its having a 
 fatal result is diminished. It is stated that during the Crimean 
 War, 1854 to 1856, and also the South African or Boer War, 
 more soldiers died from typhoid fever than were killed in 
 battle. 
 
 When Sir F. Treves spoke of flies as being one of the 
 two plagues which he met with during his attendance on 
 the sick and wounded during the South African War, he 
 probably had in his mind, amongst other considerations, 
 their influence in the propagation of typhoid fever. 
 
 TETANUS, OR LOCKED JAW. 
 
 Very valuable knowledge has been acquired during 
 
 recent years in reference to the circumstances under which 
 
 tetanus arises, and the benefits which have resulted from the 
 
 curative and prophylactic, or preventive treatment of it by
 
 66 SIXTY-FOUR YEARS A DOCTOR 
 
 antitoxic serum. Of course, the most important fact in 
 connection with the subject was the discovery of the micro- 
 organism called the bacillus tetani, by Nicolaier and Kitasato. 
 In making my remarks I wish to acknowledge with gratitude 
 the assistance which I have received from consulting the 
 text books in use by students and practitioners when I 
 commenced my medical career, and those which are the 
 recognised authorities of to-day. Amongst the former I 
 must mention Sir Thomas Watson's lectures on " The 
 Principles and Practice of Physic," and Druitt's "Surgeon's 
 Vade Mecmn," and amongst the latter, "A Manual of 
 Surgery," by Rose and Carless, ninth edition, and "The 
 Practice of Medicine," by Frederick Taylor, eleventh 
 edition, and Hale White's " Materia Medica." If it had 
 been possible for these gentlemen to know what pleasure 
 I have experienced at 85 years of age, when disabled by 
 difficulty in walking and fear of falling, from taking active 
 exercise in the open air, I think they would not blame me 
 in any way, even for sometimes quoting their exact words. 
 Tetanus is a local infective disease due to the bacillus 
 tetani, associated with a characteristic form of blood poison- 
 ing. The bacilli, or their spores, are found to be very widely 
 disseminated, and indeed are present in almost every sample 
 of garden or field soil, stable refuse, and dust, and dirt of 
 any kind. They have been found in the grime on a working- 
 man's hand, and on dirty surgical instruments. Agricultural 
 labourers are especially liable to the disease owing to their 
 more constant exposure to infection. Horses are peculiarly 
 susceptible to tetanus, and the bacilli are usually present in 
 the foeces ; hence stablemen and others brought into contact 
 with horses are attacked with comparative frequency. 
 Serious street accidents, especially those due to tram cars 
 and motor vehicles, are only too likely to be followed by 
 tetanus. The depressed vitality of the tissues, owing to the 
 bruising and tearing, favour the development of the tetanus 
 baciUi. Hence it is rare for the disease to affect wounds 
 where strict asepsis has been maintained and rapid repair 
 has been effected, and it is very uncommon, though possible,
 
 SIXTY-FOUR YEARS A DOCTOR 67 
 
 for it to develop after blows or bruises with no breach of 
 surface. Gunshot wounds due to blank cartridges are often 
 followed by it, since the injury is largely due to the wad 
 which is made of coarse horse-hair felt, and is therefore 
 likely to contain spores of the bacilli. Commercial gelatin, 
 derived from the hoofs, etc., of horses, often contain the 
 bacilli, and the injection of this substance in the treatment 
 of aneurism has been followed by tetanus. 
 
 In places where tetanus is known to be rife, it is a wise 
 precaution to administer antitetanic serum as a preventive, 
 or immunising agent, in cases of wounds or abrasions which 
 might possibly be infected, especially if due to street accidents, 
 or it suspicious bacilli are found on microscopic examination 
 of a scraping from the deeper parts of the wound. 
 
 In addition to excision, cauterisation of the wound or 
 amputation of the limb, the specific antitetanic serum 
 prepared from the blood serum of an immunised animal 
 should be injected. The serum is purely antitoxic, and has 
 no effect upon the development of the bacilli, for the 
 destruction of which local phagocytosis, or other immunising 
 action, has to be relied on. 
 
 The mortality from cases due to injury may be as high 
 as 70 or 80 per cent., and that of other cases somewhat less. 
 Under curative treatment by antitoxin, the percentage 
 mortality may be reduced to 50 or 60, and in cases protected 
 by antitoxin immediately after injury, it is perhaps smaller. 
 
 The anodynes and sedatives which have been employed 
 in the treatment of tetanus can only be regarded as palliative, 
 and should not exclude the use of the antitoxin. 
 
 During the war with Germany the success of the prophy- 
 lactic, or preventive injections, has been established. During 
 the early months, in the fighting on the Marne and the Aisne, 
 tetanus was rife, its incidence in the wounded brought to 
 Britain being about 16 per 1,000. Since the autumn of 1914, 
 prophylactic, or preventive injections of antitoxin, were given 
 to every wounded man as a rule at the dressing stations. 
 
 The celebrated American Physician, Dr. Rush, regarded 
 tetanus as a disease of debility, and recommended the use
 
 68 SIXTY-FOUR YEARS A DOCTOR 
 
 of wine and spirits in full dose. It is curious that however 
 much wine may be swallowed by the patient, nothing like 
 intoxication is produced by it. In an instance related by 
 Dr. Currie, a chronic form of the disease lasted six weeks, 
 and in that space of time the patient drank 110 bottles of 
 port wine. The same author mentions a remarkab.e case 
 in which a horse which was attacked by tetanus, and happen- 
 ing to be a great favourite with its master, was treated with 
 wine, and got well after swallowing more port wine than he 
 was worth. 
 
 It is interesting to contrast the brief summary of the 
 causes recognised in Watson's time with those mentioned 
 by Rose and Carless in 1918. 
 
 Watson says most cases of tetanus may be traced to one 
 of two causes, which are, exposure to cold and wet, especially 
 to sudden alternations of temperature and bodily injuries. 
 
 TETANUS ANTITOXIC SERUM. 
 This is prepared on the same principles as diphtheria 
 antitoxin. We know that the tetanus toxin links itself 
 closely to the proteins of the cells of the central nervous 
 system, and that when it passes from a wound to the central 
 nervous system, it travels along the protoplasm of the nerves. 
 Unfortunately, this linking takes place almost coincidently 
 with the appearance of symptoms, and when once the linking 
 has occurred, no amount of antitoxin can dislocate it. Hence 
 antitoxin, to be of any use, must be given directly the earUest 
 symptoms show themselves. It has been injected directly 
 into the brain in the hope that it may meet and neutralise 
 the toxin before that reaches the nerve cells, or perhaps 
 unite with the cells and thus prevent the toxin from doing 
 so. A small cut is made down the bone, which is bored 
 with a drill, and the antitoxin is directly injected into the 
 cerebrum with a blunt needle. It is also given subcutane- 
 ously, intravenously, directly into the nerve from the wound, 
 and intrathecally, and this certainly seems to be the best ; 
 injection into the brain is rarely done now. No very striking 
 success has attended its use in man, perhaps because tetanus
 
 SIXTY-FOUR YEARS A DOCTOR 69 
 
 is not usually diagnosed till long after infection, and perhaps 
 because, as just pointed out, the tetanus toxin is soon very 
 firmly united with the proteids of the central nervous system ; 
 but it is well to give the intrathecal treatment a trial, using 
 as much as 5,000 units for a dose frequently repeated, and 
 if there is any likelihood that the toxin is still being absorbed 
 from the wound, 10,000 units may be given from time to 
 time intravenously. 
 
 There is, however, a certainty that it may benefit if 
 it is given directly after a patient has a wound which is 
 likely to contain tetanus bacilli, i.e., such a wound as is 
 contaminated with soil. In the late war English soldiers 
 received as a preventive 500 units subcutaneously as soon 
 as possible after the infliction of a wound, followed by 
 three similar doses at intervals of a week, and there is every 
 ground for believing that this practice is the reason why 
 the deaths from tetanus are few as compared with other 
 wars. 
 
 HYDROPHOBIA. 
 
 In 1885, Pasteur announced his discovery of a method, 
 similar to vaccination, of checking hydrophobia in man and 
 rabies in animals. 
 
 The hydrophobia microbe was discovered by Professor 
 Sormani, in January, 1903. 
 
 The results hitherto obtained have been such as to 
 indicate that we have in Pasteur's method a most powerful 
 preventive against hydrophobia, provided that the disease 
 has not been allowed too long a start. 
 
 In a report issued in 1896, it was stated that out of 
 726 cases treated, only four deaths occurred. 
 
 In his chapter on hydrophobia, written in 1871, Sir 
 Thos. Watson says: — "What can I say of the treatment 
 in hydrophobia ? There is no well authenticated case on 
 record, that I am aware of, in which a hydrophobic patient 
 has recovered. As it has been so it is still. The physician 
 that cures is death." 
 
 A British Commission of inquiry (Sir James Paget, 
 Sir Burden Sanderson, and others, appointed in April, 1886),
 
 70 SIXTY-FOUR YEARS A DOCTOR 
 
 visited Paris and reported confidence in Pasteur's treatment, 
 June 27th, 1887. 
 
 An international hospital, afterwards termed the Pasteur 
 Institute, was founded in May, 1886, and opened by President 
 Carnot, November 14th, 1888. Besides the institute in 
 Paris, similar institutions exist in other parts of France, in 
 Italy, and Russia, as well as in other parts of the world, and 
 in these similar success has been experienced. 
 
 Until the publication of Pasteur's researches in 1885, 
 the only means adopted to prevent the development of 
 hydrophobia, in a person bitten by a rabid animal, had con- 
 sisted in the cauterisation of the wound with the actual 
 cautery. Such a procedure was undoubtedly not without 
 effect. It has been shown that cauterisation, within five 
 minutes of the infection of a rabic wound, prevents the disease 
 from developing, and that if done within half-an-hour it saves a 
 proportion of the cases. 
 
 Pasteur's preventive inoculation is based on the discovery 
 that the injection of an attenuated virus in increasing doses, 
 " and in gradually increasing strength protects an animal 
 or an individual from the disease, and will even catch up 
 the poison already inoculated, and save the patient from 
 its subsequent development, if too long a start has not been 
 given." 
 
 The poison is extracted by a suitable process from the 
 spinal cord of a mad dog, and being made into an emulsion, 
 is injected into the spinal cords of a number of rabbits. 
 These cords are dried by hanging in a glass bell jar, with 
 some caustic potash at the bottom, for variable periods. 
 The virus is thus weakened in its intensity, until at the end 
 of 14 days it is completely destroyed. Individuals are 
 inoculated with portions of such cords pounded up in 
 sterilised broth, beginning with the weakest and gradually 
 increasing the strength of the injection until a preparation 
 of a cord, which has merely hung one day, is used. 
 Writing in 1896, Sir J. Lister said, " The Pasteur treatment 
 of man has been adopted in various parts of the world with 
 increasing success as the details of the method were im-
 
 SIXTY-FOUR YEARS A DOCTOR 71 
 
 proved." It is not, of course, the case that everyone bitten 
 by a rabid animal takes the disease, but the percentage of 
 those who do so, which was formerly large, has been reduced 
 almost to zero by this treatment, if not too long delayed. 
 
 HYDROPHOBIA VACCINE. 
 The most convenient places (for the inhabitants of 
 Great Britain) where the treatment is carried out is the 
 Pasteur Institute in Paris, and if the person bitten goes 
 immediately after the bite, it is almost certain he will not 
 suffer from hydrophobia. The incubation period of hydro- 
 phobia is fortunately several weeks, and hence, if the above 
 treatment is carried out, it renders the patient immune before 
 the incubation period expires.
 
 DISEASES WHICH WERE 
 
 PREVIOUSLY INCLUDED UNDER SOME 
 
 MORE GENERAL HEADING. 
 
 APHASIA. 
 
 TROUSSEAU'S definition, "A classical name for 
 loss of the cerebral faculty of speech," for 
 "loss of memory of words." The speech of 
 "Animals consists of changing tones of the voice and 
 pantomimic attitudes and gestures." There is no mention 
 of this in the 1857 edition of Watson's Lectures, but in 
 the 1871 edition there is a full and graphic description 
 of it, although nothing much had been written about it 
 between the time of Heberden and 1866. The following is 
 the account given of it more than a 100 years ago by Heberden 
 in his famous Commentaries. " The inability to speak is 
 sometimes owing not to the paralytic state of the organs of 
 speech only, but to the utter loss of the knowledge of language 
 and letters, which some have quickly regained and others 
 have recovered by slow degrees, getting the use of the smaller 
 words first, and being frequently unable to find the word 
 they want, and using another for it of quite a different 
 meaning, as if it was a language which they had once known » 
 but which by long disuse had almost forgotten." After an 
 apoplectic state continuing for several days, one person was 
 forced to take some pains in order to learn again to write, 
 having lost the idea of all the letters except the initials of 
 his two names. 
 
 LOCOMOTOR ATAXIA. 
 There is not a more interesting occupation for the mind 
 of a medical man who has been 50 years in practice than a 
 consideration of the various changes of opinion which have 
 taken place during that period in reference to the nature 
 and appropriate classification of certain diseases, of the 
 additions which have been made to the catalogue of diseases, 
 
 72
 
 SIXTY-FOUR YEARS A DOCTOR 73 
 
 and of the improved methods of treatment. If, for instance, 
 we compare the index of the edition of Watson's Lectures, 
 which was pubhshed in 1857, with the index of the last 
 edition of Taylor in 1918, an interval of 61 years, we are 
 confronted with what appears to be a great number of new 
 diseases whereas we know that they must have existed and 
 have been described under some more general heading. 
 For instance, there is no mention in the 1857 edition of 
 locomotor ataxia. In the 1870 edition of Sir Thotnas 
 Watson's Lectures, he says, " Another deiinite form of disease 
 has, witliin a comparatively recent period, been singled out 
 from the crowd of symptoms engendered by disorder of the 
 nervous system and been stamped with the hybrid title of 
 locomotor ataxy. The disease was clearly though very 
 slightly sketched, and its pathology foreshadowed by the 
 late Dr. Todd. His outline of its form was filled into a 
 complete picture by M. Duchenne of Boulogne ; while its 
 true pathology has been certified by microscopic research 
 under the practised and accurate eyes and with the peculiar 
 method of Dr. Lockhart Clarke. You suspect when the 
 patient comes to consult you that he has incipient paraplegia. 
 In fact, these cases were usually mistaken heretofore for 
 cases of paraplegia, but there is no muscular palsy, neither 
 wasting nor want of power in the muscles." We have 
 another example in aphasia. 
 
 NEURASTHENIA. 
 Neurasthenia, in these days, is a word of very extensive 
 application and is often used in cases where a medical man 
 is unable to decide what term would express a perfectly 
 correct nomenclature diagnosis. The nervous element is 
 now more than ever recognised as having an important share 
 in the production of illness. In these days of telegraphs 
 and telephones, flying through the air, in express trains or 
 in aeroplanes, and such acute competition in every depart- 
 ment of hfe that the problem how to make receipts equal to 
 expenditure is continually harassing the mind, there is a 
 fearful strain on the nervous system. Some tliink that
 
 74 SIXTY-FOUR YEARS A DOCTOR 
 
 man's nervous centres are changing ; that they are becoming 
 more prone to fatigue ; more easily the prey of morbid 
 sensations, thoughts, and actions. Whether this opinion is 
 correct or not, so prevalent has nervous exhaustion become 
 that, during the last few years, the word neurasthenia has 
 been coined to express this condition. Although there is 
 no mention of neurasthenia in the 1883 edition of Quain's 
 Dictionary of Medicine, an article is devoted to the subject, 
 in all modern works, on the principles and practice of medicine. 
 Whether this opinion that man's nervous centres are chang- 
 ing is correct or not, there can be no doubt about the fact 
 that during the last 40 or 50 years the agencies acting on those 
 centres have increased in number very materially. 
 
 According to the 1894 edition of Quain's Dictionary, the 
 term was introduced by Dr. Playfair in 1881, and spoken of 
 as "nervous exhaustion." 
 
 The word neurasthenia is applied to a group of symptoms 
 
 resulting from debility or exhaustion of the nerve centres. 
 
 Another definition is that it is a mixture of mental and 
 
 bodily disorder and irritabiHty, generally the product of 
 
 weakness. 
 
 STATUS LYMPHATICUS. 
 
 Sudden death from heart failure is often associated 
 with the condition known as " status lymphaticus." It 
 usually occurs in children, and is characterised by over- 
 growth of the tonsils and abdominal and mediastinal glands. 
 The thymus also remains enlarged. The administration of 
 an anaesthetic is by no means the only cause of death in 
 this condition, as it has been known to follow the hypo- 
 dermic injection of anti-diphtheritic serum, sudden plunging 
 into cold water, and such minor ailments as bronchitis. 
 It is usually only discovered after death, but if it is suspected, 
 the greatest care must be exercised in administering an 
 anaesthetic, since the lethal dose is usually very small in 
 such patients. Ether should be given, and for choice by 
 the open method. 
 
 THYMAS GLAND. 
 
 The thymas gland is situated behind the sternum and
 
 SIXTY-FOUR YEARS A DOCTOR 75 
 
 overlying the large blood-vessels and pericardium (the bag 
 containing the heart). It is of considerable size in the 
 embryo and in the infant. In the second year of life it 
 undergoes fatty degeneration and atrophy, and disappears 
 in the adult. In the calf and the lamb it is called the sweet- 
 bread. The thymas gland is commonly known amongst 
 butchers as the "throat bread." The pancreas, or abdo- 
 minal sweetbread is the article which would be supplied 
 in the great majority of cases by butchers asked for the 
 sweetbread.
 
 OPERATIONS OF 
 
 GREAT BENEFIT TO HUMANITY 
 
 UNDERTAKEN DAILY. 
 
 ADENOIDS. 
 
 WE now hear very frequently of adenoids, or adenoid 
 vegetation, in the plarynx, which cause nasal 
 obstruction, although little was said about them 
 50 years ago. There is no mention of them in the edition 
 of the standard work on surgery by Sir Thomas Bryant of 
 Guy's Hospital, which was published in 1878, but there is 
 a good account of their nature and treatment in the 1894 
 edition of the Science and Art of Surgery, by Sir John Eric 
 Erichsen, Surgeon to University College Hospital. 
 
 At the Preston Infirmary there was one operation for 
 their removal in 1901, 12 in 1903, 52 in 1910, 80 in 1913, 
 and 159 in 1914. 
 
 The classical description of adenoids was given by 
 WiUiam Meyer of Copenhagen, who first described their 
 clinical importance. Speaking of treatment, he says, " I 
 am not aware that any internal remedies are able to check 
 their growth. Iodine naturally suggests itself, but I have 
 never deferred the safe surgical treatment for the adminis- 
 tration of uncertain internal remedies." The operative 
 measures which he suggests are cauterisation with soUd 
 nitrate of silver, and crushing and scraping off the tumours 
 as near their base as possible. 
 
 Sir John Erichsen says the symptoms are for the most 
 part the result of the obstruction to nasal respiration, and are 
 thus identical with those produced by chronic enlargement 
 of the tonsils. The two conditions are indeed frequently 
 associated, and in any case of enlarged tonsils in which 
 signs of nasal obstruction are pronounced, the presence of 
 adenoids should be suspected. 
 
 76
 
 SIXTY-FOUR YEARS A DOCTOR 77 
 
 Adenoids, if neglected, often cause post nasal obstruction, 
 deafness, and enlargement of the cervical glands. 
 
 In children, in the course of their growth, adenoids 
 give rise to what is called the adenoid face. The face is 
 lengthened, the aloe nasi are collapsed, the upper lip is short 
 and retracted, the mouth is kept open, and a vacant expression 
 is thus acquired. Pigeon breast and a high palatal arch are 
 often present also. The mouth breathing is worse at night. 
 In articulation the consonants M and N are badly pronounced 
 because these sounds cannot be resonated in the nasal meatus. 
 Laryngismus stridulus, nocturnal enuresis, stammering, 
 epilepsy and infantile convulsions are said by some to be 
 due to adenoids. Slight cases may be improved by breathing 
 exercises, aimed at teaching the child to breathe through 
 the nose. 
 
 APPENDICITIS. 
 
 Little was heard about appendicitis until 1902, when 
 
 the beloved peace-making King Edward VII. became the 
 
 subject of it. It is interesting to recall the terms in which 
 
 the announcement was made in The Times newspaper of 
 
 June 25th, 1902. It said: "The following official bulletins 
 
 issued from Buckingham Palace yesterday were received at 
 
 first with consternation and then with the profoundest grief 
 
 and sympathy, not only throughout the British Empire, but 
 
 in every civilised comitry in the world." 
 
 Buckingham Palace. 
 
 June 24t'h, 11-15 a.m. 
 The King is suffering from " perityphlitis." 
 
 His condition on Saturday was so satisfactory that it was hoped 
 that with care His Majesty would be able to go through the Coro- 
 nation ceremony. On Monday evening a recrudescence became 
 manifest, rendering a surgical operation necessary to-day. 
 
 (Signed ) Lister, Thos. Smith, Francis H. Laking, 
 Thos. Barlow, Frederick Treves. 
 
 The operation was performed by Sir F. Treves. 
 The following was posted at Windsor: — 
 
 The King is going on very well, but will not be out of danger 
 for 48 hours. 
 
 The disease from which the King is suffering is inflammation 
 of the vermiform appendix and of the adjoining intestines of the 
 lower bowels. 
 
 If everything goes well with the antiseptics employed, and if
 
 78 SIXTY-FOUR YEARS A DOCTOR 
 
 there is no abscess, it is anticipated that the illustrious patient after 
 four days might make steady progress towards convalescence, but 
 after such an operation as he has undergone, it is not to be expected 
 that the King will be able for much exertion in less than three months. 
 
 The trouble took the form of an internal abscess, the 
 growth of which blocked the natural channel, and would 
 have involved certain death if not speedily removed. Such 
 operations invariably involve considerable risk, notwith- 
 standing the progress of modern surgery. It is stated that 
 as soon as the illustrious patient got over the anaesthetic, 
 he asked for his son, and the Prince of Wales, who was 
 permitted to see his father for a moment, was intensely 
 relieved that the operation had been so successful. At a 
 late hour the Press Association announced that the King 
 appeared to be making unexpectedly good progress, and 
 his Majesty's temperature was normal. 
 
 A medical correspondent made the following communi- 
 cation to the Press : — 
 
 Where an internal abscess has formed, caused by perforation 
 either of the bowel or the vermiform appendix, and has thus admitted 
 material from the bowel into the abdominal cavity, and peritonitis 
 occurs as a sequence, the gravity of the disease is much increased. 
 
 Appendicitis is now recognised as one of the most fre- 
 quent causes of peritonitis. Indeed the certificate of the 
 cause of death in a great many cases which were said to be 
 peritonitis ought to have been (1) appendicitis, (2) peritonitis. 
 It is a melancloly reflection that a great number of persons 
 who are alleged to have died from peritonitis would be still 
 living if their illness had occurred since the operation for 
 appendicitis was established. In April, 1867, I attended a 
 gentleman aged 33 who died from what I diagnosed as 
 peritonitis, after a few days' illness. He was one of Her 
 Majesty's Inspectors of Schools, and had been a Senior 
 Wrangler at Cambridge. I made a post-mortem examination 
 and found perforation of the appendix in two or three places, 
 and f cecal matter oozing from them. He had always been 
 a strong and healthy man, and if the operation which is 
 now saving so many lives had been available in 1867, his 
 life would probably have been prolonged for many years
 
 SIXTY-FOUR YEARS A DOCTOR 79 
 
 of useful activity. In December, 1868, I attended another 
 
 gentleman, also aged 33, who was taken suddenly ill on the 
 
 Thursday before Christmas Day, and died at 3 a.m. on 
 
 Sunday, December 25th. 
 
 In this case also I found three perforations of the 
 
 appendix on the site of softened tubercles. As the lungs 
 
 also contained tubercles, the probability of recovery after 
 
 an operation was considerably reduced. A very remarkable 
 
 circumstance in connection with this case is worth mentioning. 
 
 I called into consultation the night before the patient died 
 
 one of the most eminent surgeons in the North of England, 
 
 and he wished me to inject into the patient's rectum an 
 
 infusion, made according to a prescription, of which the 
 
 following is an exact copy : — 
 
 Common Shag Tobacco ... 50gr. 
 Boiling Water ... ... 15oz. 
 
 Infuse for half an hour, cool and strain. 
 
 Three drams to be used as an enema every half hour till symptoms 
 of collapse arise. 
 
 IAs the patient was rapidly growing weaker, I did not 
 venture to adopt the suggestion, and I was very thankful 
 that I had exercised the discretion dictated by the con- 
 sideration of " wait and see." After vomiting some blood, 
 the patient died about four hours after the eminent con- 
 sulting surgeon left the house. I have read of cases of 
 obstruction of the bowels treated by injection of infusion 
 of tobacco into the rectum, under the impression that the 
 production of faintness by this means would relax muscular 
 spasm. 
 
 Sir Samuel Wilks has called attention to the fact that 
 the disease existed and was recognised long before the term 
 " appendicitis " was applied to it, and he has shown that 
 Dr. Addison described " coecitis " or " typhitis " in his 
 regular course of lectures on medicine at least as early as 
 1836. Very little has been added since, except that which 
 relates to bacteria and surgical treatment. Moreover, the 
 distinct share of the appendix in the causation of the disease 
 was recognised, although it was not credited with quite so 
 much responsibility as we are now inclined to ascribe to it.
 
 80 SIXTY-FOUR YEARS A DOCTOR 
 
 In the Index to Sir Thomas Watson's Lectures on the 
 Principles and Practice of Physic, which was the standard 
 work when I was a medical student, neither in the 1857 
 edition nor in that of 1871, does the word coecum or appendix 
 occur, but in the chapter which enumerates the causes of 
 peritonitis there is the following passage : — 
 
 It is a curious fact that the vermiform process of the coecum 
 is not infrequently the seat of a penetrating ulcer. I have traced 
 little groups of glands in that slender tube, and I have known per- 
 foration to happen from the specific ulceration of typhoid fever ; 
 and from the accidental ulceration caused by a cherry stone lodged 
 there in one instance, and by a pellet of hard foecal matter in another. 
 The last-mentioned cause is not of infrequent occurrence. 
 
 I and others can recall, and it is a painful reflection, 
 many patients who were undoubtedly suffering from 
 appendicitis, although we were not aware of the fact, and 
 whose lives would probably have been saved by the opera- 
 tion which is now so frequently and successfully performed 
 in all parts of the world, and at all hours of the day and 
 night. An American surgeon who is in favour of an early 
 operation says : — 
 
 The affected appendix is a cap which sometimes snaps, sometimes 
 flashes, and sometimes causes an explosion, and none of us can tell 
 in advance what is going to happen. 
 
 The fact that the appendix may progress to the stage of 
 gangrene and suppuration with very few symptoms, and that 
 it is so difficiilt to ascertain without operation the extent 
 of the danger, have led to the conviction that the removal 
 of the appendix should be undertaken whenever there is 
 a certain or highly probable diagnosis of appendicitis. 
 
 GALLSTONES. 
 
 Few operations are more beneficent in their design, or 
 more successful in their result, than those which have been 
 undertaken for the removal of gallstones. The lives of 
 those who are liable to attacks of biliary colic, which 
 cannot be prevented by medical treatment, are rendered 
 miserable by the constant fear of a return of their trouble. 
 Sir Thomas Watson says : — 
 
 The pain which attends the passage of a gallstone is often
 
 SIXTY-FOUR YEARS A DOCTOR 81 
 
 dreadful. Perhaps there is no pain to which the body is subject 
 which is more severe. You will not wonder at this when you consider 
 that through a tube, of which the natural size scarcely exceeds that 
 of a goose quill, there sometimes passes a stone as big as a walnut. 
 
 The most simple and uncomplicated form of the opera- 
 tion consists in incising the abdominal wall, opening the 
 gallbladder, removing the gallstones, and stitching the edges 
 of the gallbladder to the abdominal wall, leaving a fistula 
 which heals within a few weeks. This, like many other 
 operations, could not be undertaken with safety before the 
 adoption of the aseptic method of treatment. 
 
 Before the operation for gallstones was introduced, 
 the external appliances employed were the warm bath, hot 
 fomentations to the epigastrium, the mustard poultice, 
 and the turpentine stupe. The late Dr. Heberden said : — 
 
 The pain can only be assuaged by giving and repeating opium 
 and its preparations as often as the continuance of the pain requires 
 them, and because this pain is very apt to return, the patient should 
 always be advised to keep by him, as long as the distemper lasts, 
 pills of pure opium — or what is equivalent to them- — that no time may 
 be lost in quieting a sensation which it is difficult to endure. One of 
 these pills may be taken as soon as the pain comes on, and it may 
 be repeated once or twice in the course of two hours if the pain 
 requires it. A better plan still is that of implanting an equivalent 
 quantity of morphia into the subcutaneous tissue. Dr. Prout states 
 that he has seen more alleviation afforded by large drafts of hot 
 water containing carbonate of soda in solution (one or two drachma 
 to a pint) than by any other means. 
 
 This plan of treatment is still adopted in the earlier 
 attacks of the complaint, before it has been decided to remove 
 the gallstones by operation. 
 
 GYNCECOLOGY. 
 
 The dictionary definition of gynoecology is, " The science 
 and therapeutics of diseases of woman," the knowledge and 
 medical and surgical treatment of diseases of woman. There 
 is no department in medicine or surgery in which a greater 
 advancement has been made than in gynaecology. Before 
 I went to King's College, London, in 1855, I was a pupil 
 for two years with a medical man who had one of the best 
 and most select practices in Preston, and it is interesting 
 to reCall some of my experiences during that time. The
 
 82 SIXTY-FOUR YEARS A DOCTOR 
 
 gynoecologists of to-day, and even ordinary medical men, 
 will be surprised to hear that in a case of uterine haemorrhage 
 no attempt was made to ascertain the cause, such as is now 
 incumbent on all medical men. The treatment of the cases 
 consisted in giving ergot of rye, gallic acid, and tincture of 
 perchloride of iron. A few years after I had commenced 
 practice in 1858, 1 met with a case which had a very important 
 bearing on the subject which I am considering. I was 
 requested by a lady occupying an important position in the 
 district, to visit a poor woman who was said to be dying from 
 haemorrhage caused by cancer of the uterus. She had been 
 attended in succession by four medical men, not one of whom 
 had made a vaginal examination. The house was very 
 dirty, the smeU of the room sickening, the bed and clothing 
 filthy, and the death-like appearance of the face very sadden- 
 ing. She had been abandoned by the last doctor under the 
 impression that nothing more could be expected from him 
 but a certificate stating the cause of death. It is evident 
 that this, like myriads of others, the falsity of which has 
 been disclosed by post-mortem examination, would have 
 been perfectly untrue. On making a vaginal examination, 
 I found a polypus, the size of a jargonelle pear, protruding 
 from the uterus, and attached to its inner surface by a weU- 
 defined pedicle or stalk. I had the poor woman removed 
 to the Preston Infirmary, and I divided the pedicle with a 
 pair of scissors, the polypus was easily removed with a pair 
 of forceps, the bleeding ceased, and the poor woman Hved 
 for many years afterwards in the enjoyment of good health. 
 The successful treatment of this case was one of the greatest 
 pleasures of my hfe at this period of my career, and the 
 recollection of it has furnished me on many occasions with 
 very gratifying reflections. Bearing in mind that in 1855 
 the only two affections of the female organs of generation 
 recognised by general practitioners were leucorrhoea and 
 uterine haemorrhage, it is interesting to read the classification 
 of diseases of the generative system given in the " Nomen- 
 clature of Diseases," issued in 1906, and regarded as the 
 standard work. It was compiled by a joint committee, con-
 
 SIXTY-FOUR YEARS A DOCTOR 83 
 
 sisting of representatives of the Royal College of Surgeons 
 and the Royal College of Physicians. I have seen it stated 
 that the first scientific arrangement of the diseases of 
 woman, in the EngUsh language, was given by Lawson Tait, 
 of Birmingham, in 1877. 
 
 1 . Diseases of the ovary. 
 
 2. Diseases of the fallopian tube. 
 
 3. Diseases of the uterine ligaments and of the 
 adjacent peritoneum and connective tissue. 
 
 4. Diseases of the uterus, including the cervix. 
 
 5. Diseases of the vagina. 
 
 6. Diseases of the vulva. 
 
 7. Functional and symptomatic disorders of the 
 female organs of generation. 
 
 LAPAROTOMY. 
 
 In these days, when so many people are knocked down 
 and run over by motor omnibuses, motor cars, bicycles, and 
 motor cycles, serious internal injuries are often sustained 
 which render it necessary to make an incision through the 
 soft parts between the ribs and the hips, or in other words 
 to do a laparotomy for the purpose of exploring the contents 
 of the abdomen. Before the days of aseptic surgery, this 
 procedure would have been regarded as an unjustifiable one. 
 Since its adoption, however, tears in the stomach, intestine, 
 bladder, and other organs have been stitched up, so as to 
 prevent any further escape of their contents into the peri- 
 toneal cavity, and in this way many lives have been saved 
 which would otherwise have been lost. Death from internal 
 haemorrhage has also been prevented by discovering the 
 bleeding vessel and ligaturing it. It is a very wonderful 
 indication of the advance which has been made in operative 
 surgery since the aseptic method of treatment was adopted, 
 that cases are on record in which the entire stomach has 
 been removed successfully, and that it is now no uncommon 
 occurrence to remove the kidney, spleen, gall bladder, 
 prostate gland, and uterus ; to suture a perforating ulcer 
 of the stomach, duodenum, and other portions of the intestine;
 
 84 SIXTY-FOUR YEARS A DOCTOR 
 
 to excise a diseased part of the intestine, and to unite the 
 proximal and distal ends by suture. It has now even been 
 undertaken to open the skull and remove a tumour from 
 the brain, and to open the spinal canal for the removal of 
 tumours from the spinal cord. 
 
 An American surgeon is said to have succeeded in trans- 
 planting the limb of one animal on some other animal, and 
 in the transference of vital organs, such as the kidney, from 
 one animal to another. We live in an age of wonders, and 
 it will not be surprising if what has already been done for 
 certain of the lower animals may be accompHshed for human 
 beings, 
 
 OVARIOTOMY. 
 
 Ovariotomy was one of the surgical measures from which 
 the mortality was so great before the aseptic method was 
 adopted that it had to be given up, but since its introduction 
 it has been imdertaken again and performed with such remark- 
 ably successful results as to make it clear that the aseptic 
 method of treatment was the one thing needful to complete 
 the usefulness of chloroform . The number of females who have 
 not only been rescued from certain death by the operation 
 of ovariotomy, but have been restored in the course of a 
 few weeks to perfect health, is one of the most startling facts 
 in the history of operative surgery. 
 
 At a meeting of the Medico-Chirurgical Society in London, 
 in 1850, the eminent surgeon, the late Sir W IHam Lawrence, 
 denounced the operation as perilous both to the patient and 
 to the character of the profession. 
 
 In February, 1871, Mr. Spencer Wells had performed 
 the operation 408 times. 
 
 Sir Thomas Watson considered ovariotomy one of 
 surgery's greatest triumphs. He said you may estimate its 
 value by contrasting the good prospect which it holds out of 
 perfect and permanent recovery on the one hand, and the 
 almost certain destruction of life within a few years at the 
 longest, with miserable suffering towards the end, on the 
 other. In the light of our present knowledge, it is interest 
 ing to read what Sir Thomas Watson said in 1871 : —
 
 SIXTY-FOUR YEARS A DOCTOR 85 
 
 When we have the opportunity of treating ovarian dropsy from 
 its commencement, we sometimes find that the enlarging ovary is 
 painful or tender. I have treated such cases assiduously with the 
 remedies of chronic inflammation, frequent topical bleedings and the 
 use of mercury till the gums were affected ; with the remedies of 
 ordinary dropsy, diuretics and drastic purgatives ; and with 
 remedies accounted specific ; liquor potassoe and the various prepara- 
 tions of iodine ; and I must honestly confess to you that I am 
 unable to reckon one single instance of success. Yet these are the 
 measures, if any, that we are bound to try : never further than they 
 can be carried without serious or permanent damage to the general 
 health of the patient. They have succeeded, as we are assured, by 
 competent and credible witnesses ; they may therefore succeed again. 
 The amount of my own experience, however, has led me to the belief 
 that medicine has in general very small influence over the progress 
 of this disorder. The cases that do well, we scarcely know how or 
 why ; the cases that prove fatal run their course in spite of us. 
 
 PROSTATECTOMY AND ENLARGEMENT OF THE 
 PROSTATE GLAND. 
 
 The prostate gland is at the neck of the bladder, where 
 it joins the urethra. In many men it never gives any trouble. 
 In some the gland increases in size, from two to fourteen 
 times its natural bulk, and becomes hardened. The increase 
 may be but slightly above the ordinary chestnut size of the 
 gland, or it may render it as large as a man's fist, or larger. 
 The enlargement may affect the whole organ, especially the 
 lateral lobes, pretty uniformly ; or it may affect one side 
 more than another ; or it may affect the posterior portion, 
 enlarging it into what is commonly called the middle or 
 third lobe ; a lobe, which, according to the late Sir Henry 
 Thompson, is purely the result of unnatural enlargement 
 and does not exist in health. The consequence of this is a 
 projection at the part where the bladder joins the urethra, 
 causing a most serious impediment to the passage of the urine. 
 
 The symptoms associated with an enlarged prostate 
 vary from mere inconvenience to suffering so severe as to 
 make life undesirable. 
 
 Before the operation for the removal of the gland was 
 undertaken, the most important part of treatment was the 
 use of the catheter twice a day, which was not only a great 
 nuisance, but sometimes the passage of it was attended with 
 difficulty and danger.
 
 86 SIXTY-FOUR YEARS A DOCTOR 
 
 By the modern method of removing the gland by a 
 surgical operation, the sufferer is able to dispense with the 
 use of the catheter, and to enjoy an existence which is a 
 great contrast to that which he previously experienced, and 
 to lead a useful and active life. 
 
 There was some animated correspondence in the British 
 Medical Journal in October, 1921, in reference to the claims 
 made by the friends of the late Sir Peter Freyer, that he was 
 the deviser of the operation of suprapubic prostatectomy 
 and the removal of the prostate by enucleation by the finger 
 and not by cutting. 
 
 Sir Qifford Allbutt and Messrs. Littlewood and Wilcox, 
 however, have proved conclusively that the distinction is 
 due to the late A. F. McGill, Professor of Surgery and 
 Surgeon to the General Infirmary at Leeds. He described 
 at a meeting of the British Medical Association at Leeds on 
 August 18th, 1889, that he had already successfully per- 
 formed the suprapubic operation, and he laid great stress 
 on the fact that the mucous membrane was incised with 
 scissors and the enucleation carried out with the finger, 
 and that it was better to operate by a suprapubic than by 
 a urethral or perineal route. In an adjoining room there 
 was the astounding and unique spectacle of seven or eight 
 old men sitting on a bench with their prostates in bottles 
 on their knees. Each patient had a card attached to him 
 setting out briefly the clinical history of his case. Sir 
 Clifford Allbutt and Messrs. Littlewood and Wilcox give 
 Sir Peter Freyer credit in the following terms : — 
 
 As aseptic surgery was elaborated his judicious! boldness 
 urged its performance at earlier and earlier periods of pro- 
 static disorder, and so under less and less adverse conditions. Thus 
 insistently and successfully he brought the method into general 
 acceptance, and achieved a great work for which he will be remem- 
 bered as one of the benefactors of mankind. 
 
 McGill pointed out that Belfield, of Chicago, had per- 
 formed the operation in May, 1886. 
 
 In reference to prostatectomy. Rose and Carless say : — • 
 
 The operation, however, is not unaccompanied by danger, and 
 if the patient can easily pass a catheter for himself, and is free from 
 any other complication, it seems hardly justifiable to submit to an 
 operation which may prove fatal.
 
 SIXTY-FOUR YEARS A DOCTOR 87 
 
 Mr. R. H., an elderly man, who had for several years 
 been afflicted with prostatic trouble, was persuaded by me 
 to go to London and consult Mr. Reginald Harrison in 
 reference to the desirability of undergoing prostatectomy. 
 Mr. Harrison advised him strongly to submit to this form 
 of treatment, although he was a very stout man and was 
 very nervous, and engaged rooms for him at a nursing home 
 in Devonshire Street. As I was anxious to see the operation, 
 which was to me a new method of treatment, Mr. Harrison 
 kindly consented to operate at nine o'clock on Sunday 
 morning in order to give me the opportunity of attending 
 the service at the Foundling Hospital Chapel in GuUdford 
 Street, which had been my favourite place of worship when 
 I was a student at King's College. I went up to London on 
 Saturday evening and returned on Sunday. I took with 
 me as a guest my friend the late Dr. J. E. Garner, who was 
 very anxious to perform the operation at the Preston 
 Infirmary and to be better prepared for doing so. Not- 
 withstanding that the patient was a bad subject for an 
 anesthetic, all passed off well. Mr. Reginald Harrison did 
 the laparatomy and Mr. Thomson Walker the prostatectomy. 
 
 The man left Preston with nothing before him but a 
 painful and miserable existence ; he returned in good spirits, 
 perfectly cured, and for many years after led an active, 
 useful and comfortable life. Dr. Garner and I went to both 
 the morning and afternoon services at the Foundling Hos- 
 pital. At the latter we sat in the loft with my friend Dr. 
 Wetton, the organist. 
 
 TUBERCULOUS GLANDS IN THE NECK. 
 I remember the time when I used to meet people in the 
 street whose faces presented evidence of having had small 
 pox. They were said to be pock-marked, and the marks 
 consisted of httle pits or holes left by the scar of the healed 
 small pox pustule. Such faces were also deprived of what 
 may be called " The roseate hue of health," owing to the 
 destruction of some of the minute blood-vessels supplying 
 the skin. It is now very many years since I saw a pock-
 
 88 SIXTY-FOUR YEARS A DOCTOR 
 
 marked person. For the disappearance, or comparative rarity, 
 of small pox, we are, of course, indebted to the blessing of 
 vaccination. I still meet with children and young persons 
 whose necks are disfigured by enlarged glands and ugly, 
 red-coloured puckered scars, the existence of which causes 
 great anxiety and worry to parents and much weeping on 
 the part of some of the children, especially young girls. The 
 administration of iodine in its various forms with iron and 
 cod liver oil, and change of air to the seaside, or a dry, 
 bracing atmosphere, and the outward application of iodine, 
 good food, good clothing, are still regarded as important 
 aids to the prevention and cure of enlarged glands in the 
 neck, but within the last few years it has become the 
 practice, in cases considered suitable, to remove the glands 
 with the knife, and, therefore, instead of the ugly, puckered, 
 discoloured scars and enlarged glands, to have merely the 
 line of the incision, which may be almost unnoticed. 
 
 Tuberculous glands in the neck for several centuries 
 were called " King's Evil," and were formerly supposed to 
 be cured by the King's touch. The first Enghsh King who 
 touched was Edward the Confessor in 1058. In the reign 
 of Charles II., 92,107 persons were touched , and according 
 to Wiseman, the King's physician, they were nearly all 
 cured. Queen Anne officially announced in the London 
 Gazette, 12th March, 1712, her intention to touch pubhcly. 
 The custom was dropped by George I., 1714. In the reign 
 of James II., 1684, the remedial power of the King's touch 
 in cases of evil was firmly believed in by others than the 
 vulgar, for it appears the Corporation of Preston voted 
 the sum of five shillings each to two poor women afflicted 
 with this disease towards the expense of travelling to Chester 
 to avail themselves of the supposed potency inherent in 
 Royal fingers. This absurd superstition was not entirely 
 discountenanced till the reign of George I., 1714. It is on 
 record also that the Corporation of Preston also paid ten 
 shillings to a bricklayer to take his son to London to be 
 touched for King's Evil in 1684. It is said that in the time 
 of Edward the Confessor, Royal healing for scrofula was
 
 SIXTY-FOUR YEARS A DOCTOR 89 
 
 looked upon as something of a novelty compared with the 
 practice in France, where at an earher period it was an 
 estabHshed custom. 
 
 Until about 1860, the treatment of suppurating and 
 caseating glands in the neck consisted in little more than 
 the appUcation of poultices and iodine paint. The first note 
 of the change which was beginning to revolutionise the 
 practice of the physician and the surgeon in this disease 
 was struck by Professor Clifford Allbutt in a paper at the 
 International Congress of Medicine in 1881. This paper was 
 followed up by the publication, in 1885, of a cHnical lecture 
 by Professor Allbutt and Mr. T. Pridgin Teale, who was 
 one of my fellow students at King's College, in which further 
 experience of the operation was set forth. 
 
 Rushton Parker, of Liverpool, was early in the field 
 as an advocate for operative treatment of cervical glands. 
 In 1872 he wrote an article in the Liverpool and Manchester 
 Medical and Surgical Reports with the title of " Extirpation 
 of tuberculous lymph glands." 
 
 It is rather curious to observe that John Browne, who 
 was surgeon in ordinary to Charles II, while upholding the 
 Royal prerogative of touching for the disease and praising 
 its efficacy, really anticipated the surgical treatment of 
 tuberculous glands, as carried out by Pridgin Teale, and 
 others, who were regarded as the pioneers of this method. 
 His method was extirpation and removal, the only difference 
 being the after treatment. 
 
 He has much to say regarding the Royal touch : 
 
 I have been oft conversant and attending at many of these 
 laudable operations, having waited upon his sacred person, both at 
 pubhc and private healings, as one of his meanest chirurgians, where 
 I have seen many thousands of poor souls touched and cured by 
 his sacred hand. 
 
 With regard to this remedial power of the Sovereign 
 being firmly believed in, there are abundant proofs. Browne 
 himself affords one, for he was one of the surgeons who 
 examined and prepared the patients at the ceremonies for 
 healing. Wiseman himself recorded that the King cured
 
 90 SIXTY-FOUR YEARS A DOCTOR 
 
 more in any one year than all the surgeons in London did 
 in an age, and the College of Physicians itself reported on 
 the case of a man who claimed to possess this Royal power 
 of healing, and pronounced him an imposter, which leaves 
 one with the inference that the College recognised this Royal 
 power to healing. Browne's book, in which he summarises 
 cases to prove the efficacy of the Royal touch, received the 
 imprimature of the College. 
 
 THYROIDECTOMY. 
 The thyroid body is composed of two oval bodies which 
 are situated in the neck, one on each side of the windpipe, 
 and are connected together by means of an isthmus, or narrow 
 strip, which crosses its upper rings. Frequently one lateral 
 lobe is larger than the other, and occasionally the middle 
 lobe, or isthmus, is solely or principally affected. The enlarge- 
 ment is called bronchocele, goitre, or Derbyshire neck. 
 Sometimes the enlargement continues until it causes difficulty 
 of breathing by its pressure on the windpipe, and dif&culty 
 in swallowing by compressing the oesophagus, and it impedes 
 the circulation of blood in the head and neck by pressure 
 on the blood vessels. In cases where this happens, an opera- 
 tion becomes necessary to remove the whole or a portion of 
 the gland. The modem operation of thyroidectomy is a 
 great improvement on that which was originally undertaken, 
 and which consisted in removing the whole of the gland. 
 Total extirpation results in myxoedema, but as long as a 
 sufficient portion of the secreting substance is left, whether 
 it is derived from the isthmus or one of the lobes, this evil 
 does not result. Myxoedema is a disease in which the thyroid 
 body is atrophied, and the connective tissue of the skin, 
 liver, kidneys, and the other organs are partly converted 
 into a mucous or gelatinous substance. Where the enlarge- 
 ment is not very considerable, the internal administration, 
 or external application of iodine, and other medical treatment, 
 is the usual course. It is known that aU sufferers from 
 myxoedema have atrophied thyroid glands. If a preparation 
 of sheep's thyroid is given to patients suffering from myxce-
 
 SIXTY-FOUR YEARS A DOCTOR 91 
 
 dema, all the symptoms usually disappear in about six weeks, 
 although the patient's thyroid remains atrophied. The 
 effect is one of the most striking experiences in medicine. 
 It is known that human beings whose thyroid is excised 
 become myxoedematous, and that all sufferers from myxoe- 
 dema have atrophied glands. 
 
 A patient of mine who lived in a neighbouring street 
 had an enlargement of the th57roid gland, which, during 
 four years, gradually increased in size until it compressed 
 her windpipe, and the blood vessels, and nerves, and muscles 
 of her neck to such an extent that she could not lie down 
 in bed without producing a sense of suffocation, and this 
 feeling was also produced by raising her arms. Extirpation 
 had for some years been practically abandoned on account 
 of the alarming bleeding which was associated with the 
 operation. With improved methods, however, it was at 
 this time again undertaken with encouraging success. As 
 my patient's life was a very painful one, and she was in 
 danger of suffocation, I succeeded in persuading her to go 
 to the infirmary, where partial extirpation of her thyroid 
 was adopted by my friend and neighbour. Dr. Collinson. 
 This occurred 15 years ago ; she is now 70 years of age ; 
 she can walk briskly and a considerable distance, and she 
 is leading a happy, healthy, and useful life. 
 
 Thyroid Gland. 
 At one time it was believed that the thyroid gland 
 poured a secretion into the blood, the nature and purpose of 
 which was unknown. It is now thought : — 
 
 (1) That it exercises a powerful influence or control 
 over the development and destruction of cells which is 
 constantly going on within us from the time of our birth 
 to the hour of our death. 
 
 (2) That it breaks down exhausted cells and 
 governs the elimination of the waste products of their 
 disintegration. 
 
 (3) That it defends the body against invasion by 
 disease-producing organisms and injury by their products.
 
 92 SIXTY-FOUR YEARS A DOCTOR 
 
 (4) The administration of thyroid gland leads to 
 
 a gradually increased oxidation of all the tissues, and 
 
 rapidly reduces the bodily weight. 
 
 Formerly the advice usually given was : — "So long as 
 the disease is merely a deformity, so long as it does not 
 interfere with any of the important functions of the body, 
 nor produce serious discomfort, the surgical operation for 
 the removal of the thyroid gland is not recommended by 
 most authorities." At one time extirpation was regarded as 
 exceedingly difficult and dangerous as the arteries are so 
 much dilated in these cases that perilous haemorrhage might 
 be expected from their division, especially when in close 
 proximity to the caroted arteries. 
 
 In one case where excision was attempted, the haemorrhage 
 was so alarming that the surgeon was obliged to desist in 
 the middle of his task, and the patient actually died of 
 haemorrhage a few days afterwards. The operation was 
 wholly abandoned by surgeons until the improved methods 
 adopted to-day came into use. 
 
 Twenty years ago a lady friend of mine who also suffered 
 from the pressure of an enlarged thyroid gland, underwent 
 the operation of thyroidectomy shortly after the dread of 
 excessive bleeding had been removed by improved methods 
 of operating. She was able to leave the nursing home at 
 the end of a month, and ever since has enjoyed excellent 
 health. 
 
 TAPPING THE CHEST. 
 The operation of tapping the chest, which is now per- 
 formed so very frequently, must have been a somewhat 
 unusual occurrence ten years before the introduction of 
 Lord Lister's principles. Writing in 1857, Sir Thomas 
 Watson, one of the most eminent physicians of that day 
 and a colleague of Sir William Ferguson, said : — 
 
 On six occasions I have myself witnessed the evacuation by 
 puncture from the human pleura of a clear, transparent liquid. 
 Three of the patients recovered, and three died. Again I have twice 
 seen pus let out by the primary puncture of the chest. One of these 
 recovered, and the other died. This constitutes the amount, or 
 nearly so, of my personal experience of paracentesis thoracis.
 
 SIXTY-FOUR YEARS A DOCTOR 93 
 
 When I see fluid let out of the chest with the beautiful 
 aspirator and similar appliances, I recall the only occasion 
 on which I saw paracentesis thoracis performed at King's 
 College Hospital. It was in 1858, and the patient was under 
 the care of Dr. George Budd. The fluid was conveyed not 
 through an india-rubber tube into a basin, but through 
 a piece of chicken's intestine, the distal end of which rested 
 xmder the surface of water contained in a bucket. 
 
 REMOVAL OF LOOSE CARTILAGES FROM THE 
 KNEE JOINT. 
 
 Since football became such a popular game, this operation 
 is very frequently performed. 
 
 If each footballer who has had a loose cartilage removed 
 from his knee joint were to write a few lines expressing his 
 gratitude for the relief which he has obtained, and if these 
 testimonials were sent to a central of&ce to be entered in a 
 book, the record for even 12 months only would be a very 
 voluminous and impressive one. 
 
 The symptoms caused by this condition are produced 
 by the loose body being occasionally caught between the 
 articular surfaces of the femur and tibia, leading to a 
 temporary locking of the joint, and severe pain owing to 
 the stretching of the ligaments. The pain is sometimes 
 momentary, but sometimes continuous until the painful 
 locking of the joint has been removed by manipulation 
 either with or without an anaesthetic.
 
 INSTRUMENTS USED 
 IN THE INVESTIGATION OF DISEASE. 
 
 MOST people are familiar with many instruments and 
 appliances for the investigation and treatment of 
 disease which are in daily use at both special and 
 general hospitals, but there are others of great usefulness 
 which are not so well known. A few remarks on the clinical 
 thermometer which were made by Sir Thos. Watson soon 
 after it came into use, about the year 1862, are of great 
 interest. 
 
 THE CLINICAL THERMOMETER. 
 According to Sir Samuel Wilks the instriiment did not 
 come into general use until about the year 1860. He says : — 
 
 I requested the Superintendent at Guy's to procure a clinical 
 
 thermometer I think it was nearly a foot long and was 
 
 so great a novelty that it was taken to a South-Eastern meeting of 
 the British Medical Association for exhibition, where the members 
 regarded it with much curiosity and interest, although, I am sorry 
 to say, one or two with ridicule. 
 
 Dr. Archibald Arnott is said to have used a thermometer 
 while attending Napoleon in St. Helena in 1821. 
 
 Dr. Wunderlich, Professor at Leipzig, wrote the first 
 important and practical treatise on the subject. This was 
 reviewed by Sir CUfford AUbutt in the British and Foreign 
 Medical Review, vol. 45, 1870, in which he says : — 
 
 The first clinical thermometers made in this country were those 
 of Casella under the direction of Dr. Aitken, and for hospital purposes 
 they cannot be improved. They are, however, too cumbrous for 
 general practice. ... I hope it is no undue presumption on my part 
 to please myself with the notion of having had a share in introduc- 
 ing the thermometer into general practice. ... I applied to Casella, 
 but he had no pocket thermometers, and seemed indisposed to make 
 any. I therefore set to work with Messrs. Harvey & Reynolds to 
 manufacture one. 
 
 Writing in 1871, Sir Thomas Watson says: — 
 
 What is called the thermometry of disease is a subject upon 
 which, within the last few years, much new light has been thrown, 
 and about which a very lively interest has been re-excited. The 
 measures of temperature of the body were heretofore altogether 
 vague and imperfect, having been furnished either by the subjective 
 
 94
 
 SIXTY-FOUR YEARS A DOCTOR 95 
 
 feelings of the patient himself or by the objective tactile feelings 
 of the bystanders, both of which are not only wanting in precision 
 and accuracy, but apt to be even fallacious and deceptive. Yet we 
 all know from the use of that familiar instrument, the thermometer, 
 that degrees of heat are capable of being expressed numerically 
 and therefore with absolute accuracy. What was so long needed 
 for giving exactness or scientific value to the varying temperature 
 of the human body in fevers, was some method whereby the exact 
 degree of its heat from time to time might be ascertained and re- 
 corded, and such a method has now been reahzed. Analysis of the 
 record obtained by thermometry brings to hght a series of fixed laws 
 by which the varying degrees of the bodily temperature are regulated : 
 laws which are seen at once to be profitable for the diagnosis, the 
 prognosis and the treatment of febrile disorders. You may thus 
 learn to what species of fever a given case belongs ; the stage which 
 it has reached, whether it is running its natural course ; to what 
 mode of termination it is tending ; may test the efficacy and value 
 of therapeutic measures and discriminate between real and only 
 seeming convalescence. The importance of such information is 
 great and obvious ; and (unlike the methods of auscultation and 
 palpation) this method demands no previous or special education 
 of the senses ; all that is requsiite being carefulness, patience, and 
 clear eyesight. 
 
 I obtained my first clinical thermometer about the 
 year 1862. It was made by Casella, and was in a mahogany 
 box. It had to be read whilst the bulb was in the arm-pit, 
 as there was no register, and a temperature above normal 
 began to fall as soon as it was withdrawn. I gave the above 
 to the Harris Free Library and Museum. 
 
 We owe the great service in the study of disease which 
 the clinical thermometer has conferred upon us to Dr. 
 Wunderlich, of Leipzig. It came into use several years 
 after I had commenced practice, and its value was pointed 
 out by Sir Clifford Allbutt, the Regius Professor of Medicine 
 at Cambridge and previously a consulting physician at Leeds. 
 Its unreliability in inflammation of abdominal organs was 
 impressed upon me by a case which came within my own 
 experience. I was asked to make a post-mortem examination 
 of an old gentleman who died from malignant disease of the 
 lower part of the colon, the rupture of which I discovered had 
 set up acute peritonitis. The patient had either suffered little 
 inconvenience until the accession of the peritonitis, or he 
 failed to complain of any. Shortly after the clinical thermo- 
 meter came into use, Sir W. Roberts, of Manchester, one of 
 the most powerful advocates in this neighbourhood for the
 
 96 SIXTY-FOUR YEARS A DOCTOR 
 
 use of the thermometer, was summoned by the gentleman's 
 medical attendant to give his advice and assistance. Sir 
 William surprised the local doctor, who had diagnosed 
 peritonitis, by saying that he was sure there was no peritonitis, 
 as the thermometer showed that the temperature was normal. 
 
 THE STETHOSCOPE. 
 In 1816 Laennec, of Paris, by rolling a piece of paper 
 into a kind of cylinder, and applying one end to the patient's 
 chest and the other to his own ear, perceived the action of 
 the heart in a much more distinct manner than by the 
 immediate application of the ear. This led to his inventing 
 the stethoscope, or breast explorer. The principle of this 
 was known by Hippocrates (357 B.C.) and by Robert 
 Hooke, 1681.
 
 MODERN INSTRUMENTS. 
 
 NOT the least wonderful are some of the modern instru- 
 ments used for the direct inspection of the bronchi, 
 oesophagus, stomach, and bladder. These instru- 
 ments are illuminated by means of a small cold electric 
 lamp at the distal end. The lamp slides along a fine tube 
 which protects its entire length. 
 
 THE H.EMACYTOMETER. 
 It will surprise many people to know that there 
 is an instrument called the haemacytometer to count the 
 number of red and white corpuscles in the human body. 
 
 THE H^MOGLOBIMETER. 
 There is also another called haemoglobimeter for estimating 
 the extent of departure from the natural amount of colour- 
 ing matter in the blood. The information thus gained is 
 of great importance in such diseases as anaemia, chlorosis, 
 leuchcemia, malaria and pernicious anaemia. 
 
 THE PULSE. 
 "When I began practice, the points which I had been 
 taught to observe were the number in the minute, the 
 volume, the force or resistance, the beat occurring at regular 
 or irregular intervals, intermission or missing of beats, the 
 special character as in some forms of heart disease, and the 
 effect of posture. 
 
 THE SPHYGMOGRAPH AND THE 
 SPHYGMOMANOMETER. 
 In relation to the pulse there are two valuable instru- 
 ments called the sphygmograph and the sphygmomano- 
 meter, the former for tracing on paper the beating of the 
 pulse and the other for recording, with mathematical pre- 
 G 97
 
 98 SIXTY-FOUR YEARS A DOCTOR 
 
 cision, the strength of the beats and so indicating whether 
 the pulse is of high or low tension. 
 
 THE SCOLIOSIOMETER. 
 
 Another useful instrument which is not generally known 
 is the scoliosiometer. Scoliosis is a term applied to lateral 
 curvature of the spine, and the scoliosiometer is an instnmient 
 for accurately measuring the amount of deformity of all forms 
 of asymmetry, as well as spinal. It is found of service in the 
 investigation of fractures and dislocations, in comparative 
 measurements of opposite sides of the thorax and abdomen, as 
 in cases of thoracic and abdominal tumours, or any unilateral 
 bulgings from pleural collections, contraction changes following 
 these, unequal muscular development, in obtaining a reliable 
 register of chest measurement, and expansion for recruit 
 examination and insurance work, and lastly in craniometric 
 work. 
 
 THE ELECTRO-MAGNET. 
 
 We have recently added to our equipment at the 
 Preston Infirmary a very powerful electro-magnet for the 
 extraction of particles of metal from the eye. Previously, 
 as the magnet which we possessed was not sufficiently 
 powerful, we had to send many cases to the Manchester 
 Eye Hospital. As there was thus an unavoidable interval 
 between the receipt of the injury and the arrival of the man 
 at the Manchester Eye Hospital, the delay often resulted in 
 the loss of the eye.
 
 TREATMENT. 
 
 DURING everyone's lifetime there are days and years 
 when events occur which are recorded in the 
 memory and are recalled easily by some people 
 and with difficulty by others, or the remembrance of them 
 comes into the mind spontaneously. The occurrence is often 
 associated with some date such as Christmas Day, or Easter, 
 or Whit-Monday, or with a pleasant or painful experience 
 of some sort. A few days ago I read a paragraph in the 
 newspaper stating that much amusement was caused to a 
 judge and the people in a court of justice by the reply of a 
 witness to the question, " How do you manage to fix the date 
 of the occurrence so accurately ?" His answer was, 
 " Because it happened on the first Sunday in the month, 
 and I always have my bath on the first Sunday in the 
 month." In my own lifetime there have been what I may 
 call certain " Milestones," the reflections on which have added 
 very much to the interest and enjoyment of my life. My 
 " Milestones " may be divided into two classes — those which 
 are directly associated with my own profession and those 
 which are not. It is, however, impossible to draw a distinct 
 line of demarcation between the two. Some of the most 
 important of my " Milestones " are : 1836, the year in 
 which I was born ; 1846, when ether was discovered ; 
 1847, chloroform ; 1867, the aseptic method of treatment ; 
 1882, the tubercle bacillus ; and 1895, the X-rays. 
 
 There is not a more interesting occupation for the 
 mind of a medical man who has been 50 years in practice, 
 than a consideration of the benefits which have resulted 
 to himianity from the discovery of chloroform, aseptic 
 method of treatment, the bacilli of tubercle, diphtheria, 
 typhoid fever, tetanus, hydrophobia, and that all infective 
 diseases are due to specific micro-organisms. 
 
 The discovery of the laryngoscope, ophthalmoscope, 
 and other appliances and their usefulness in the investigation 
 
 99
 
 100 SIXTY-FOUR YEARS A DOCTOR 
 
 of disease have led to the establishment of special hospitals 
 for the treatment of diseases of the eye, ear, throat, nose, 
 and other parts of the body. The importance of special 
 hospitals has now been realised to such an extent that many 
 of the general hospitals are providing separate departments 
 within their enclosures. Some of the most recent additions 
 are due to the more extensive use of light, heat, electricity 
 and massage. 
 
 The number of diseases which in the early part of my 
 career were treated medically, but are now cured by surgical 
 operations, is constantly increasing. I could not bring 
 forward a more striking illustration than that which is 
 afforded by the common diseases, adenoids, appendicitis, etc. 
 
 SURGERY. 
 
 The progress of surgery and its auxiliaries, between 
 1836 and 1921, have conferred upon mankind benefits and 
 blessings which cannot be too higlily appreciated, although 
 their great value is apt to be overlooked on account of our 
 familiarity with them. A certain lady who is now a dis- 
 tinguished gynaecologist predicted that, in connection with 
 her department, events would occur which would stagger 
 humanity, and that if anyone had attempted to prophesy 
 in 1836 that such operations as now came under the category 
 of the surgery of the abdomen would be performed in 1921, 
 he would have been regarded as a limatic. I heard the 
 late Sir W. Mitchell Banks tell his audience, at the opening 
 of the Liverpool Royal Infirmary operating theatre by 
 Sir F. Treves, October 10th, 1902, 20 years ago, that if in 
 the earlier part of his career he had attempted to perform 
 operations which he was then undertaking as a portion of 
 his daily work, he would have landed himself in the hands 
 of the police. The mention to him of such operations as 
 gastro-enterostomy, or the removal of the entire uterus or 
 the prostate gland, would have made him shrug his shoulders 
 and use some of the impressive language with which his 
 friends were familiar. 
 
 It is very interesting to recall a number of operations
 
 SIXTY-FOUR YEARS A DOCTOR 101 
 
 which are performed daily in the Infirmaries of the United 
 Kingdom : Adenoids, appendicitis, gynsecology, laparotomy, 
 ovariotomy, prostatectomy, removal of loose cartilages from 
 the knee joint, removal of gallstones, removal of tuberculous 
 glands in the neck, thyroidectomy, tapping the chest. 
 
 BLOODLETTING. 
 Bleeding from the arm, or the external jugular vein, 
 was becoming less and less frequent when I commenced 
 the study of medicine. It is still occasionally employed 
 with benefit when a patient is becoming cyanosed, that is, 
 the face and more or less of the surface of the body of a 
 blue colour and asphyxia is threatening either : — 
 
 (a) As a result of engorgement of the lungs from 
 incompetency of the mitral valve owing to the heart 
 being unable to drive the blood through all parts of 
 the body, or 
 
 {b) As a result of some accident involving the chest 
 wall and lungs, whereby the blood aerating surface is 
 so diminished that it cannot deal with the blood reaching 
 it through the right side of the heart, which hence 
 becomes enormously distended and threatens to stop in 
 a dilated condition 
 
 (c) Where inflammation of the brain is pending and 
 the pulse is hard and full, or 
 
 {d) In a few inflammatory states in strong fuli 
 blooded individuals where the pulse tension is liigh. 
 
 Rose and Carless, Manual of Surgery (1918). 
 
 This is the only mention in Taylor : " The withdrawal 
 of blood to the extent of 10 or 12 ounces by an opening in 
 the external jugular, or basilic vein, at once relieves the 
 engorged condition of the right venticle, which can then 
 contract efficiently on its contents." 
 
 Taylor's Practice of Medicine, 1914. 
 
 In the index the reader is referred to its employment 
 in nearly 20 diseases. Watson's Lectures, 1871.
 
 102 SIXTY-FOUR YEARS A DOCTOR 
 
 Bleeding from the arm once or twice a year was for- 
 merly a popular operation, but is now comparatively rarely 
 practised. In the Accounts of Accidents, whatever the nature 
 of the accident might have been, a stereotyped sentence 
 that " A Surgeon came and bled the sufferer " might have 
 been anticipated. If anything could extinguish the spark 
 of life flickering after the shock of a severe accident, it must 
 have been the senseless, unmeaning custom of bleeding, 
 when perhaps brandy and water or ammonia were required. 
 At one time in the country it was difficult to persuade people 
 that bleeding was not required after an accident, and all 
 bad consequences were attributed to the omission of the 
 mysterious agency of bloodletting. 
 
 When Sir James Paget, one of the most eminent surgeons 
 and pathologists, was an apprentice with a surgeon named 
 Costerton at Yarmouth, 1830 to 1834, he writes : — 
 
 Among the patients who came to the Surgery, not a few, 
 especially women, came to be bled. For at that time there were 
 many, especially among the country working people, who deemed 
 bleeding once or twice a year a great safeguard, or a help to health. 
 They came frequently on market days at the times of spring and fall, 
 and generally did their day's work in the market and then walked 
 to the surgery. There they were at once bled, and usually were bled 
 till they fainted, or felt very faint and became pale ; then a pad was 
 put over the wounded vein, and a bandage round the elbow ; and they 
 went home, often driving three or four nailes into the country. I 
 have no recollection of any evidence that either good or harm was 
 ever done by this practice. 
 
 TRANSFUSION. 
 
 An interesting item in connection with the blood is the 
 transference of blood from one individual to another. It 
 has, however, now been recognised that the success of the 
 proceeding depends on the introduction of a sufficient 
 quantity of fluid as a temporary substitute for the blood 
 which has been lost, rather than on its quality. It has been 
 proved that the transfused blood of another person is rapidly 
 destroyed and eliminated. Hence transfusion has now in 
 many cases been replaced by the infusion of some bland 
 fluid, of equal tension with the blood plasma, and by this 
 means greatly improved results have been obtained. A warm 
 saline solution is the best, consisting of a dram of chloride
 
 SIXTY-FOUR YEARS A DOCTOR 103 
 
 of sodium to a pint of sterilised water at a temperature 
 of 105 F. to llOF. 
 
 A few weeks ago The Lancashire Daily Post called 
 attention to an appeal which had appeared in the Press 
 from the London Temperance Hospital for persons who 
 were willing to give a pint and a half of blood to a patient 
 in the hospital, a woman aged 50 who was suffering from 
 acute anaemia and was face to face with death unless she could 
 obtain a supply of life fluid. Eight persons volunteered. 
 The odds were considerably against a person having the right 
 blood in her veins for transfusion, but "we hope to find one 
 from the eight persons who have volunteered," said an 
 ofl&cial of the Hospital. 
 
 35 Volunteers. 
 A woman inmate of the Home for Friendless Women 
 became seriously ill, and was sent to a Montreal hospital. 
 The doctors, after an examination, decided that the only 
 hope for her recovery was the transfusion of some one's 
 blood. Every one of the 35 inmates of the home promptly 
 volunteered, and the first transfusion was successfully made. 
 
 Transfusion Record. 
 Thomas Shaw, aged 26, known among the Philadelphia 
 medical men as the " Blood King," has contributed (says 
 the Daily Express) more than 21 quarts of blood in 26 trans- 
 fusion operations. Shaw is a grocery shop assistant. He 
 states that he has suffered no ill effects after parting with 
 as much as a quart of blood, and this he attributes to his 
 strict vegetarian diet, and to his drinking much water. 
 
 THE USE OF MERCURY IN PNEUMONIA, &c. 
 When I was a pupil with Mr. Thomas Dixon, from 1853 
 to 1855, it was his custom, and it was also the practice of 
 contemporary doctors on meeting with a case of pneumonia 
 or pleurisy, to prescribe some form of mercury, and to continue 
 the use of it until the gums grew red and spongy ; the patient 
 complained that his gums were sore, that he had a metallic
 
 104 SIXTY-FOUR YEARS A DOCTOR 
 
 taste, like that of copper, in his mouth, and an unpleasant 
 and characteristic odour in his breath. As people differed 
 in their susceptibility to the influence of mercury, the soreness 
 and other effects of the drug occasionally went further than 
 was intended, and owing to the greatly increased secretion 
 of saliva, the patients were said to be salivated, and the 
 doctor had to submit to more or less censure. 
 
 The mercury was administered under the belief that 
 it was a powerful agent in controlling adhesive inflammation, 
 such as glues parts together and spoils the texture of organs. 
 Sir Thomas Watson said in the earlier editions of his lectures, 
 "The great remedial property of mercury is that of stopping, 
 controlling, or altogether preventing the effusion of coagul- 
 able lymph ; of bridling adhesive inflammation ; and if 
 we in our turn could always bridle and limit the influence 
 of mercury itself, it would be a still more valuable resource." 
 
 With reference to pneumonia. Sir Thomas Watson says, 
 " When the inflammation has reached the second stages, 
 that of solidification, mercury ought to be administered. 
 The object of it is to make the gums tender ; and it is 
 expedient to do this as speedily as may be . . . ." 
 
 Speaking of the treatment of pleurisy. Sir Thomas 
 Watson says, " Mercury, from its well-known power to check 
 the effusion of coagulable lymph, is especially indicated. 
 Where there is evidence of effusion of fluid into the cavity 
 of the pleura, the object of our treatment is to get rid of the 
 fluid, and with this object in view we keep the gums tender 
 with mercury." 
 
 It is very interesting to read the following remarks in 
 Taylor's "Practice of Medicine," 11th Edition, 1918: — 
 
 It is almost certain that no drug has any direct influence upon 
 the inflammatory process as such, though much assistance may be 
 obtained by influencing the resisting processes and supporting the 
 heart in severe cases. 
 
 The following are the remedies employed in the treat- 
 ment of pneumonia to-day : — 
 
 External Appliances. 
 Linseed meal poultices, linseed meal poultices sprinkled
 
 SIXTY-FOUR YEARS A DOCTOR 105 
 
 with mustard, hot flannels wrung out of turpentine, ice or 
 ice between flannels. 
 
 Medicines. 
 
 Liq. amm. acet. or liq. amm. cit., or pulv. ipecac, co. 
 (Dovers powder) to maintain a free action of the skin, reme- 
 dies to procure sleep, to maintain the action of the heart, 
 and oxygen gas to oxygenate the blood. 
 
 Excluding treatment on bacteriological lines, and by 
 immune sera and bacterial vaccines and blood letting and 
 the use of mercury, the treatment of pneumonia is much 
 the same as it was 50 years or more ago. 
 
 DIET. 
 Regvflations in reference to this subject were always 
 part of the treatment of disease, but more precise rules are 
 adopted in the present day based on the nature of the food 
 suitable for particular cases. 
 
 DRUGS. 
 Fresh drugs are constantly being introduced, and many 
 of the older ones still retained, e.g., liq. amm. acet., liq. amm. 
 cit., sp. oetheris. nit., sodii bicarb., sp. amm. co. 
 
 THE INTRODUCTION OF DRUGS. 
 
 The older methods of administration by the mouth and 
 rectum, and friction with ointment and embrocations are 
 stfll in use. Morphia, strychnia, cocaine, and others, by the 
 subcutaneous syringe, are now introduced by hypodermic, 
 intra musculae, intravenous, and intraspinal injections. 
 Medicines are also administered by ionisation. In this 
 method decomposable salts, of which one or both of the 
 component elements are efficient drugs, are applied to the 
 skin and decomposed by a galvanic current, so that the 
 nascent elements or ions are driven at once into the tissues 
 and exert the desired effect. 
 
 ORGANO THERAPY. 
 Extracts of various organs of animals, thyroid, sup-
 
 106 SIXTY-FOUR YEARS A DOCTOR 
 
 rarenal gland, pituitary body are given internally or per 
 rectum or by subcutaneous injection, to supply defects in 
 the corresponding organs in the human subject. 
 
 ANTITOXIC AND ANTIBACTERIAL SERA. 
 As in diphtheria, hydrophobia, tetanus, and typhoid. 
 
 BACTERIAL VACCINES. 
 A vaccine is a solution containing several million dead 
 bacteria of the same species as those of the disease requiring 
 treatment, and preferably cultivated from some obtained 
 from the patient to be treated. For example, the expectora- 
 tion of a chronic bronchitis patient and the discharge from 
 the gums in pyorrhea are used. The injection of these bac- 
 teria increases the opsonic power of the patient's blood 
 serum, and thus assists in the ultimate destruction of the 
 bacteria causing the disease. 
 
 OPSONINS. 
 Bodies which act on the bacteria so that they are more 
 readily digested by the leucocytes. 
 
 HEAT. 
 Besides the local application of warmth for purposes 
 of stimulation or counter-irritation, and of heat for its 
 destructive effects (cautery), radiant heat, by means of 
 incandescent electric lights, is employed for the local treat- 
 ment of rheumatic joints and allied conditions. 
 
 DIATHERMY. 
 A more recent method of applying heat locally. The 
 heat is produced by continuously maintained high frequency 
 currents, and in this form it penetrates more deeply into the 
 part, e.g., a joint, than any heat that can be borne, supplied 
 by sources external to the limb. 
 
 LIGHT. 
 The general advantages of a bright sunny climate are
 
 SIXTY-FOUR YEARS A DOCTOR 107 
 
 well known, and even in less clear climates it is of use, in some 
 complaints, to expose the patient to bright sunlight when- 
 ever the opportunity offers. The Finsen light treatment of 
 lupus and rodent ulcers consists in directing an intense light 
 upon the diseased part for specific periods of time. The 
 light consists of violet and ultra-violet rays, and is produced 
 by an arc-light from which the heat rays are cut off. 
 
 ROENTGEN RAYS OR X-RAYS. 
 
 The powerful effects of these light -rays are well known, 
 both for good and evil. Constantly playing upon the un- 
 protected skin, as in the case of X-ray operators, they have 
 caused intense and incurable dermatitis. Used with proper 
 precautions for Umited periods, they modify the growth of 
 cells in the body, and have been of value in the treatment 
 of rodent ulcer, cancer, enlarged glands, leukaemic spleen, 
 syringomyelia, ringworm, and other affections. They cause 
 a slow degeneration of the cells, acting more upon the 
 pathological than upon the healthy cells. At a certain point 
 vascular dilatation with extravasation of phagocytes occurs. 
 
 RADIUM. 
 
 The rays emanating from this substance have also 
 powerful effects for good and evil. Radium is being used 
 extensively for the treatment of cancer, especially in the 
 deeper passages, where surgery is difficult. 
 
 ELECTRICITY. 
 
 The employment of electricity in the investigation and 
 treatment of disease has been greatly developed during 
 recent years. It had long been known that electricity 
 possessed properties allied in some degree with the mani- 
 festation of nervous force, but it was not until much new 
 light had been thrown on the subject by patient investiga- 
 tions, and by the construction of new and ingenious instru- 
 ments for its administration, that its importance and value 
 as a curative agent has been generally accepted. 
 
 The chief uses of this force have been in the treatment
 
 108 SIXTY-FOUR YEARS A DOCTOR 
 
 of paralysis and other nervous diseases. Muscles which 
 cannot be stimulated by the will can be made to contract 
 by electric stimulation, so long as their nutrition is normal 
 and they are not the subject of atrophy. This contraction, 
 effected at stated intervals, maintains the circulation of blood 
 and lymph in the muscles, and facilitates the return of health. 
 Such contractions can be effected by the faradic, or by the 
 continuous current. Many painful neuralgic affections are 
 benefited by a continuous current of electricity. Another 
 application of electricity now often used is that of high- 
 frequency currents. These are currents of high potential, 
 perhaps 10,000 volts, alternately positive and negative, and 
 changing their sign about every millionth part of a second. 
 They are constantly too rapid to stimulate sensory nerves, 
 or motor nerves or muscles, which can only respond to stimuli 
 of about 1-1 0,000th second duration ; nevertheless, they have 
 certain effects upon the tissues, which are claimed to be 
 increased cellular activity, changes in the vascular system, 
 and inhibition, i.e., diminished susceptibility of the neuro- 
 muscular system to ordinary stimuli. 
 
 BATHS AND DOUCHES. 
 By this means heat and cold and mechanical effects 
 may be produced, and so the vasomotor system and the 
 circulation may be effected both locally and generally. 
 Medicated baths, alkaline baths, and sulphur baths are 
 extremely useful in some circumstances, and water giving 
 off carbonic acid in minute bubbles is claimed to have a 
 decided effect even upon the size of the heart's cavities. 
 The hot air bath and vapour bath are valuable means of 
 promoting diaphoresis or sweating. 
 
 SUBSTANCES DERIVED FROM THE ANIMAL 
 KINGDOM. 
 
 Thyroid Gland. 
 A powder prepared from the fresh and healthy thyroid 
 gland of the sheep.
 
 SIXTY-FOUR YEARS A DOCTOR 109 
 
 It is known that human beings, the whole of whose 
 thyroid is excised, become myxoedematous, and that all 
 sufferers from myxoedema have atrophied thyroid glands. 
 If a preparation of sheep's thyroid is given to patients 
 suffering from myxoedema, all the symptoms disappear 
 usually in about six weeks, although the patient's thyroid 
 remains atrophied. The effect is as striking as anything 
 in medicine. It is best to begin with 5gr. thrice a day, to 
 gradually increase the dose till lOgr. are given, and when all 
 the symptoms have disappeared it will be necessary for 
 about lOgr. to be taken twice a week for the rest of the 
 patient's life, to prevent recurrence. When the treatment 
 was first introduced the glands were eaten, or transplanted 
 under the skin, or the extract was administered subcutane- 
 ously ; but equally good results are obtained by giving the 
 liquor or the powder by the mouth ; tablets of the powder 
 are very convenient and much used. A dimunition of 
 certain goitres follows the giving of the thyroid, but it is 
 useless in exophthalmic goitre. Cretinism is also mar- 
 vellously benefited, both mentally and bodily, by thyroid 
 preparations, especially if given early in the patient's life. 
 A few cases of imbecility in children, a few of climacteric 
 insanity, and a few of tetany have been much improved 
 by thyroid. Chronic psoriasis, which has resisted all other 
 treatment, often disappears if the patient is put to bed 
 and takes daily enough of thyroid preparations to keep him 
 on the brink of poisoning by them, but, unfortunately, the 
 disease often returns when the treatment is discontinued. 
 
 Thyroid preparations have been used for obesity, but 
 the practice is not to be recommended. They must be 
 carefully given to those suffering from cardiac disorder. 
 A preparation called iodothyrine, said to contain the active 
 principle of the gland, has been used lately. 
 
 Pituitary Extract. 
 Is prepared from the pituitary body of the sheep. The 
 pituitary body is a portion of the brain which was formerly 
 called the pituitary gland. Pituitary extract is usually
 
 110 SIXTY-FOUR YEARS A DOCTOR 
 
 given subcutaneously. It is an admirable circulatory 
 stimulant acting within a minute or two of injection. It is 
 of great use in cardiac failure during severe operations, and 
 to a less extent in severe fevers, e.g., pneumonia when the 
 pulse is failing ; indeed it may be used in cardiac failure 
 due to any cause. The effect soon passes off, but it lasts 
 much longer than that due to adrenalin. It is much used 
 instead of ergot to produce uterine contraction whenever 
 that is required, and is occasionally very useful in severe 
 constipation and to get the bowels to act after operations. 
 Sometimes they are opened instantly after everything else 
 has failed. It has also been given to promote the secretion 
 of mUk. If a second injection is given, it should be several 
 hours after the first, for experiments show that a 
 second injection quickly following a first often produces 
 collapse. 
 
 Pepsin. 
 An enzyme obtained from the fresh and healthy stomach 
 of a pig, sheep or calf. Pepsin and its preparations are 
 given to help digestion. 
 
 Enzyme. 
 A name for soluble ferments, or any ferment formed 
 within the living organism. 
 
 LiQUORPANCREATIS. 
 
 A solution of the digestive principles of the fresh 
 pancreas of the pig. Pancreatised foods are often useful 
 for those whose digestions are weak. 
 
 Suprarenal Extract or Adrenalin. 
 
 It is obtained from the suprarenal glands of animals, 
 from a capsule above the kidneys. 
 
 Adrenalin causes contraction of the small arteries. 
 It is used with much advantage to stop bleeding, such as 
 that from the nose or uterus, before operations on adenoids, 
 turbinated bones in the nose, or piles.
 
 SIXTY-FOUR YEARS A DOCTOR 111 
 
 MASSAGE AND ELECTRO-MASSAGE. 
 
 The effect of the manipulations in massage is to promote 
 the flow of lymph and blood in their respective vessels, and 
 to stimulate the muscles, the skin, and the skin reflexes. 
 
 On August 22nd, 1921, on the occasion of the laying of 
 the foundation stone of the new Electro-Massage Department 
 of Preston Infirmary, Dr. Derham, the medical officer, said, 
 " Massage was an old subject, as also was electricity, but it 
 took the terrible war to bring to their notice the valuable 
 aid that the combination of the two things would be to the 
 public. The work was quite distinct from X-Ray work 
 and light treatment. It was for dealing with injuries to 
 muscles and joints. Men in the Army had had access to 
 the treatment, but the civiUans had not, and what had been 
 valuable to the soldier would also be useful to the civilian 
 in lessening the period of invalidism. Formerly, when a 
 wound had healed, or a fractured bone had knitted, a man 
 was thought to be cured, but until the limb was able to 
 function, the real cure was not effected. That was the 
 mission of electro-massage, and its object was to return a 
 man to his family as a bread-winner, and not as a drone — 
 a very important step indeed." 
 
 It was highlj' creditable to all concerned that that 
 institution should be so early in the field in that department 
 of treatment. 
 
 The value of the new electro-massage department will 
 also be realised in connection with the treatment of what 
 are called medical cases, as distinguished from those 
 mentioned by Dr. Derham, which belong to the categorj'' 
 of surgical cases. There is an interesting passage in Watson's 
 Lectures, 1871, in reference to the employment of massage 
 (although the term was not then used), and electricity. 
 Speaking of hemiplegia, or paralysis of the arm and leg, 
 he says, " It will, therefore, be proper in cases of protracted 
 paralysis to promote, and, if possible maintain the nutrition 
 of the idle muscles by friction and pressure, by shampooing, 
 by calling them repeatedly into action by artificial exercise 
 through the stimulus of galvanism or of electricity. Our
 
 112 SIXTY-FOUR YEARS A DOCTOR 
 
 aim must be to preserve the muscular part of the locomotive 
 apparatus in a state of health and readiness, until, per- 
 adventure, that portion of the brain from which volition 
 proceeds having recovered its function, or mode by which 
 its messages travel having been repaired, the influence of 
 the will shall again reach and re-animate the palsied limbs." 
 
 ARTIFICIAL MOVEMENTS. 
 
 Swedish and other Artificial Movements. 
 
 All these are active movements made by the patient 
 himself under the direction of the physician or operator, 
 with the object of providing a daily amount of exercise either 
 locally or generally, in relation to the functions of the joint, 
 or to the powers of a weak heart, or to the cure of obesity, 
 or to the working of the digestive functions, or as in the case 
 of Frenkel's exercises, the object may be the re-establish- 
 ment of the function of co-ordination in muscular movements. 
 
 The system of treatment initiated by Schott and others 
 at Nauheim is also supplied at various British Spas. It 
 consists partly of immersion in saline baths ; partly of 
 regulated exercises of the arms, trunks, and legs, conducted 
 slowly against resistance on the part of the attendant. An 
 elaborate series of movements has been devised, comprising 
 flexion and extension at all the large joints, these movements 
 being made by the patients, but gently opposed throughout 
 by the attendant. No movement is repeated at the same 
 sitting. An interval of rest occurs between any two suc- 
 cessive movements, and indications of strain or dyspnoea, 
 or distress are the signals for stopping the exercises. It is 
 allowed that the waters of Nauheim may be successfully 
 imitated by the addition to other waters of equivalent pro- 
 portions of sodium chloride (1 to 3 per cent.), or calcium 
 chloride ("2 to "5 per cent.), or sufficient quantities of bi- 
 carbonate of sodium and hydrochloric acid to cause effer- 
 vescence. 
 
 Oertel's method consists of a systematic combination 
 of hill climbing, with a diet in which fluids and fat-forming 
 elements are reduced to a minimum.
 
 SIXTY-FOUR YEARS A DOCTOR 113 
 
 In Frenkel's method, the patient is conducted from 
 simple rhythmical to more complicated movements, and is 
 made to pay such attention to them as to ensure a thorough 
 education. The movements are active, and consist in flexion 
 and extension of the legs to minimum, maximum, and inter- 
 mediate extents, while recumbent, sitting or standing ; 
 in moving the foot from point to point in a regular methodical 
 manner ; in walking slowly on marked lines, straight, and 
 zig-zag, or in marked footsteps, forwards, sideways, and 
 backwards, &c. They should be carried out three times 
 daily, at first for 10 or 15 minutes, and later for half an hour to 
 an hour. Massage may be usefully employed at the same time. 
 
 DISEASES OF TROPICAL CLIMATES. 
 
 The researches which have been made in connection 
 with many of the diseases which are prevalent in tropical 
 climates have led to the discovery of the specific micro- 
 organisms which are concerned in their causation, and to 
 the establishment of methods for the prevention and cure 
 of them. A few years ago I read an announcement from the 
 Colonial Office that from July 1st the " Sleeping Sickness 
 Bureau " will be known as the " Tropical Diseases Bureau." 
 The reconstituted bureau will deal with all exotic diseases 
 which are prevalent in tropical and sub-tropical regions, 
 and will publish at frequent intervals a Tropical Diseases 
 Bulletin. The Director will have the Assistant Director and 
 a number of experts, who will be responsible for the different 
 subjects, and will furnish authoritative reviews and summaries 
 of published papers to appear in the Bulletin. Thus the 
 results of the most recent researches on every tropical disease 
 in every country, new methods of treatment, and improved 
 means of prevention will quickly become available for the 
 remote worker in the Tropics. 
 
 CAMBRIDGE RESEARCH HOSPITAL. 
 
 A Research Hospital is no ordinary institution, and 
 we shall realise this when we bear in mind the momentous
 
 114 SIXTY-FOUR YEARS A DOCTOR 
 
 possibilities in relation to life and death, to rich and poor, 
 and to the learned and unlearned, which are involved in the 
 work to be carried on in it. Who would have thought it 
 possible, fifty years ago, that Pasteur's researches in con- 
 nection with putrefaction, which prepared the way for Lister's 
 discovery and aseptic method of treatment, would have 
 produced such far-reaching and life-saving results, and such 
 incalcidable benefits to mankind ? Who can tell what may 
 result from the work carried on in the Cambridge Research 
 Hospital. 
 
 The work carried on at the Research Hospital at 
 Cambridge has a four-fold object : — 
 
 (1) To give relief to the individual patient. 
 
 (2) To benefit others suffering from similar diseases 
 by throwing light on their origin and treatment. 
 
 (3) To discover means of preventing their onset 
 in those at present healthy. 
 
 (4) To impart the knowledge thus gained to others. 
 There are numerous ailments, such as rheumatoid 
 
 arthritis which, though not immediately threatening the life 
 of the sufferer, often last many years, and finally leave the 
 patient helpless, a burden on public charity or private 
 benevolence. These diseases have received comparatively 
 little attention from those who devote themselves to original 
 research. Such diseases are, as a rule, unduly neglected in 
 research, although they cause a far greater sum of human 
 suffering than do the acute disorders which are so much 
 more striking in their manifestations, and more dramatic 
 in their cure. These diseases incapacitate the sufferer from 
 active work, cause great pain and misery, and finally leave 
 the victim helpless. Patients suffering from these diseases 
 owing to the slow progress and long continuance of their 
 iUness, are not suitable for reception into General Hospitals 
 which, as a rule (and rightly so), admit by preference, cases 
 of the more acute diseases. The mode of origin, or progress 
 of these affections, is very imperfectly known, and Uttle, 
 therefore, can be done in the way of their rational treatment. 
 The great need of scientific research on these chronic diseases
 
 SIXTY-FOUR YEARS A DOCTOR 115 
 
 has been strongly felt by the medical profession for many 
 years. To the sufferers themselves, these diseases mean 
 virtual loss of all enjoyment in life, and in the case of persons 
 who have to earn their living — disablement from active 
 work. Yet nothing can be more pitiable than the state of 
 the victims of these chronic diseases, such as rheumatoid 
 arthritis, their condition may be one of almost ceaseless pain, 
 making life an almost uninterrupted torture. 
 
 RESEARCH LABORATORIES. 
 
 Research Laboratories and similar institutions have 
 been founded with the object of providing every practitioner, 
 who desires it, the assistance which can be rendered by a 
 fully equipped laboratory in the investigation and treatment 
 of disease. 
 
 Instruction is given as to the exact way in which the 
 necessary material should be collected and forwarded for 
 investigation, and the deductions which may be justifiably 
 drawn from the results obtained are sent to the practitioner 
 concerned. 
 
 If a medical man suspects that a patient has tubercle 
 bacilli in his expectoration, in many instances he sends a 
 specimen of it to one of these institutions. Similar assistance, 
 though the information is not often so conclusive, is given 
 in connection with typhoid fever. Very valuable guidance 
 is also given in reference to a morbid growth as to its being 
 of a malignant or non-malignant character. 
 
 Although all medical men are supposed to acquire a 
 knowledge of the work carried on in a research laboratory, 
 many do not become sufficiently expert to undertake the 
 work themselves, and comparatively few have sufficient 
 time at their disposal for the necessary investigation. 
 
 CONCLUSION. 
 
 A consideration of the subjects which I have endeavoured 
 to discuss suggests various reflections. One of them is that 
 if, during the last 85 years such marvellous discoveries have
 
 116 SIXTY-FOUR YEARS A DOCTOR 
 
 been made, what may be expected during the next 85 years. 
 Another is that we ought to be very thankful that we have 
 been allowed to live during a portion of a century which 
 has been more remarkable than any of its predecessors for 
 the discovery of inventions and appliances which have added 
 so much to the interest and enjoyment of life. It would be 
 an interesting exercise of the imagination to consider what 
 the life of people was during the 85 years which intervened 
 between 1751 and 1836, and to compare it with the experience 
 of those who have lived during the whole, or a portion, of the 
 interval between 1836 and 1922. 
 
 Lord Avebury, or Sir John Lubbock, as he was better 
 known, says in one of the chapters in his Pleasures of Life, 
 " What language can be strong enough to express the 
 gratitude we ought to feel for the advantages we enjoy ! 
 We do not, I think, appreciate our good fortune in belonging 
 to the nineteenth and twentieth centuries."
 
 REMINISCENCES OF PERSONS. 
 
 SIR CLIFFORD ALLBUTT. 
 
 I HAD the pleasure of making Sir Clifford AUbutt's 
 acquaintance in March, 1906, when he wrote to me 
 from 4, Esplanade, Ambleside, stating that he should 
 like, on his way to London, where he had to attend a meet- 
 ing of the Athenasum Committee on April 3rd, to call and 
 thank me personally for my financial assistance in connec- 
 tion with the Research Hospital Movement at Cambridge. 
 In acknowledging the receipt of his letter I invited him to 
 dine with me and make my house his home for the night. 
 
 Preston. 
 
 Your cordial letter settled my arrangements very quickly. The 
 2-25 p.m. from Windermere, arriving at Preston 4-10 p.m., was that 
 on which my eye also had lighted, but I did not feel sure if this might 
 invade your day's work a little too soon. I am glad it will just give 
 time for us to visit the Preston Infirmary. On Monday next, then, 
 please expect me at 4-10 p.m., and if you are unexpectedly detained 
 as is so frequent with us, pray do not mind meeting me as you so 
 kindly propose. I shall drive direct to your house. 
 
 It seems rather a cool proceeding to trespass upon your hospitality 
 in order personally to thank you for your beneficence. If I may take 
 you at your kind word, and come to Preston the previous night, April 
 2nd, I would leave Preston 11-11 a.m. for Euston in the morning of 
 April 3rd. 
 
 I had fortunately another visitor the same evening in 
 Dr. Colin Campbell, of Southport, who said that he had 
 experienced the guidance of Sir Clifford when he was practis- 
 ing in Leeds as a Consulting Physician. I took them to see 
 the Infirmary, the Harris Library and Museum, and the 
 School of Domestic Science, with all of which they were very 
 much pleased. I was delighted to find that Sir Clifford was 
 interested in my Chamber Organ, and he told me that although 
 he was able to play, he considered himself " More of an organ 
 builder than player." 
 
 Shortly afterwards I received an invitation from Dr. 
 Dreschfeld, of Manchester, to be his guest for the night to 
 
 117
 
 118 SIXTY-FOUR YEARS A DOCTOR 
 
 meet Sir Clifford Allbutt, whom he was also entertaining 
 on the occasion of an important meeting of the Manchester 
 Pathological Society. 
 
 On July 15th and 16th, 1906, I spent at St. Radegundes 
 two very pleasant days, and I was much impressed with the 
 kindness of Sir Clifford and Lady Allbutt. Sir Clifford came 
 to the Cambridge Station on his bicycle to meet my train, 
 and cycled alongside me as I walked to his house, which was 
 not far from the Station. Lady Allbutt was on the door- 
 step of St. Radegundes to welcome me on my arrival. Next 
 day Dr. T. P. S. Strangeways, the Huddersfield Lecturer on 
 Pathology, and one of the most enthusiastic advocates of 
 the Research Hospital Movement, conducted me over several 
 of the Colleges, and in the evening Sir Clifford Allbutt took 
 me to dine with him at St. John's College, where I had been 
 once before as the guest of the late Sir John Gorst. 
 
 The occasion of the second visit to Sir Clifford Allbutt 
 was my opening of the Research Hospital at Cambridge, and 
 to receive the Honorary Degree of M.A. on May 24th, 1912. 
 
 In the evening Sir Clifford had a dinner party at which 
 were Sir Norman Moore, the President of the Royal College 
 of Physicians ; Dr. Shipley, the Master of Christ's College ; 
 Professor Sims Woodhead and T. P. S. Strangeways, and 
 others. The next morning I went on the invitation of Dr. 
 Shipley to see Christ's College, and the rooms which were 
 occupied by my two brothers from 1848 to 1851, and from 
 1852 to 1855. 
 
 Extracts from Sir Clifford Allbutt's Letters. 
 
 Professor Van Gehuchten of Louvain. 
 
 Among the Belgian Refugees has come to Cambridge, Professor 
 Van Gehuchten, Professor of Neurology at Louvain. Are you willing 
 to accept him as a candidate for your studentship ? He is a man of 
 high reputation in Neurology, and thus well known to all by name, 
 and now personally. He is a man I should say about 50, full of vigour 
 and marvellously elastic, as all these Belgians are, under his affliction. 
 
 All his manuscripts destroyed, poor fellow ! We really think 
 that it is a most happy opportunity of securing a first rate Neurologist 
 to work the nervous side of rheumatoid arthritis, wasting of muscles, 
 pain, &c.
 
 SIXTY-FOUR YEARS A DOCTOR 119 
 
 Many thanks for your kind permission re Van Gehuchten. Sir D. 
 Ferrier tells me that he is not good second rate, and not only first rate, 
 but " Tip Top," and the way he is going about his research work is 
 most skilful, and equal to his modesty. 
 
 We got a little more money for Professor Van Gehuchten, bring- 
 ing this up to ;^200. He started off three or four weeks ago in 
 brilliant form. Very skilful. Last Monday he had a pain in the 
 left hypochondrium, repeated next day with signs of illness. Waring 
 kindly came down from St. Bartholomew's without fee, operated, and 
 set the kink free, and he is doing well. 
 
 You will, I am sure, be shocked to hear that Professor Van 
 Gehuchten is dead. I saw him at one o'clock at the Convalescent. 
 Cheery, pulse and heart good, talking of getting up, and probably 
 would have been fit to do so. He wrote the enclosed letter to me 
 yesterday. He died of syncope. Yet how strange he should have 
 survived the operation so well. It is a sad loss to us both as a friend 
 and fellow worker. I suppose mental distress and harass shook him 
 to the foundations of life. 
 
 Personal. 
 
 You have displayed a discrimination, a wisdom, and the large 
 view of the sphere of Science, which directed your gifts to the best 
 purpose. 
 
 Speaking of the microscope which I sent to the Research 
 
 Hospital, he says : — 
 
 It is a lovely instrument. There are only three in all our Science 
 departments to compare with one belonging to Strangeways and 
 yours. 
 
 Speaking of a photograph in which I was taken with 
 General Booth, he says : — 
 
 The General is a glorious old man, and I will venture to say that 
 your association with him in one picture is in congruity. The dietary 
 is interesting. I wonder how many years he observed it strictly. 
 
 It is a great gratification to me on your election to the Fellowship 
 of the Royal College of Physicians. Cambridge, in whose work you 
 have taken so warm an interest will be much gratified to hear of your 
 honour, and the gratification of Lancashire will be no less. 
 
 One would have hoped that at our age chronic ailments would 
 have had their chance, and failed. My hope is that I may pass away 
 in some gentle way, before I become invalided. So far I still ride 
 my bicycle, and do a lot of work, but I get more tired, but hope it is 
 only the hot weather. 
 
 Preston. 
 
 You told me and shewed me many interesting things, but none 
 more interesting than the housewifery scheme.
 
 120 SIXTY-FOUR YEARS A DOCTOR 
 
 The Matron of the Hospital at Malton, Miss Lorimer, who is a 
 devoted disciple of yours, was at the Preston Hospital. She is a great 
 success here. 
 
 I was much impressed by your Hospital, for we get into the way 
 of thinking that Hospitals don't rise to their best without the lively 
 criticism of the School of Medicine, and that it does in Preston, speaks 
 volumes for the up-to-dateness of its Staff. I have never seen a more 
 taking operation room, so nice and efficient, and may I say of such a 
 sad place, cheerful. 
 
 Research Hospital. 
 
 It is so wonderful as you say to see these men devotedly working 
 here like Strangeways, on mere pittances, or like many others who 
 prefer to live and work here for the higher knowledge of hfe, on incomes 
 of ;^500 to ;^600 a year. Professors, &c., who could earn perhaps five 
 to ten times as much in the world as Electrical Engineers, Medical 
 or Law Professors, &c. It makes me think hopefully of one's species. 
 With reference to the Research Hospital (as it is not my idea), I can 
 permit myself to say that it is a most fertile, practical, and masterly 
 m.ethod, and so far as I know, original, and is even unique. It merits 
 every help which you and other friends may feel disposed to give to it. 
 Have you not a spare milUonaire up your way to send us ? 
 
 We have now got the Research Hospital back from the Govern- 
 ment, and I think a few patients are already in residence. 
 
 Strangeways, during this time of War stoppage, has completed 
 a superb series of Pathological specimens, and a large series of coloured 
 drawings. 
 
 We seem still incomplete on Rheumatoid Arthritis, and not able 
 to go forward to another disease. Suspended by the War the work 
 is going regularly forward. 
 
 Sir Clifford Allbutt's Letters. 
 
 Visit of German Physicians. 
 
 It will interest you to hear that the Council of the Research 
 Hospital has so fairly impressed the German Physicians, who usually 
 know nothing outside Germany, that a deputation of three of them 
 (sent by one of the first authorities of the day, Miiller of Munich), 
 went over, and were much impressed. Miiller, whom I know well, 
 told me afterwards it was one of the most impressive events of his 
 visit to England, both the idea, and the work done. 
 
 Commendation of Assistance in Research Hospital. 
 
 I believe you are helping forward in the field of medicine the 
 most promising and fertile movement of the time. 
 
 Prince Leopold X-Rayed. 
 
 You may be interested to hear that with the X-Ray apparatus 
 which you gave us, we photographed the knees of Prince Leopold of 
 Battenburg, who is up here, and needs every care, but is fairly well 
 at present.
 
 SIXTY-FOUR YEARS A DOCTOR 121 
 
 MR. HORACE BARLOW. 
 
 For many years Mr. Horace Barlow has been the 
 Assistant Librarian of the Royal College of Physicians, 
 and I have frequently received kindness and attention from 
 him when I visited London. 
 
 In writing " Sixty-four Years a Doctor," I have con- 
 sulted him on several points, and he has given me valuable 
 help. 
 
 He had a great friend and admirer in the late Sir William 
 Osier, who invited me to meet Mr. Barlow at dinner at the 
 Automobile Club, in the early part of 1914, before the 
 War. 
 
 SIR THOMAS BARLOW. 
 
 The name of Barlow is a household word in Bolton 
 and the neighbourhood, and Sir Thomas is one of the most 
 distinguished members of the family. 
 
 The first time I had the pleasure of seeing him was at 
 a Conversazione at the Royal College of Physicians, when 
 he was President. The occasion was memorable, as, if I 
 am not mistaken, there had not been one for 20 years. It 
 was a gathering of distinguished men in the scientific and 
 medical world. Every possible provision was made to give 
 them an appropriate entertainment, and the Conversazione 
 was in every sense a magnificent success. I had never before 
 had the pleasure of seeing Sir Thomas, but had corresponded 
 with him in reference to patients. One incident which added 
 very much to my pleasure was my introduction by him to 
 Sir James Mackenzie. 
 
 LIEUT.-COL. BARON BENTINCK. 
 The Baron served during the Boer War in 1900 in the 
 Rifle Brigade, and was appointed Deputy Commissioner at 
 Vereeniging shortly before the peace was signed. He was 
 engaged in France during the recent War for two years, and 
 was invalided home. Subsequently he was in charge of 
 the Records Office at Preston for three years. Shortly before
 
 122 SIXTY-FOUR YEARS A DOCTOR 
 
 last Christmas he went with his wife and only son to Switzer- 
 land and Italy, and he has written me such a graphic and 
 interesting account of what he saw and heard that I shall 
 read his long letter again with a geography and atlas at my 
 side. 
 
 I made the acquaintance of the Baron under somewhat 
 peculiar circumstances. One day when consulting Dr. T. 
 H. Miller, a dental surgeon well known in Preston, he asked 
 him if he could tell him of anj^one who could give him the 
 name of the composer of a chant which he had heard at 
 St. George's Church. Dr. Miller referred him to me, and I 
 had no difficulty in giving him the information that it was 
 composed by C. J. Yates, who was the organist of St. George's 
 Church for 40 years, and with whom I had been well 
 acquainted. After this introduction, and until the Baron's 
 three years of service at the Records Office had expired, he 
 was a frequent visitor at my house, and it was a great pleasure 
 to me to play the organ to a friend who appreciated sacred 
 music so much as he did. 
 
 MR. W. T. BEST. 
 
 Mr. W. T. Best, Organist of St. George's Hall, Liverpool, 
 opened the new grand Willis Organ at St. George's Church, 
 Preston, in September, 1865. I heard, with much pleasure, 
 his splendid musical recital. 
 
 I afterwards dined at the Victoria Hotel with him, 
 my brother-in-law, Mr. T. M. Shuttleworth, Mr. Birchall, 
 one of the Churchwardens, and his son, Arthur, who designed 
 the beautiful oak case of the organ. 
 
 Shortly after we commenced the dinner Mr. Best threw 
 away his table napkin and said sharply to the waitress, 
 "Take that napkin away — it is damp! " When I asked him 
 what was the matter, he said he was afraid of getting rheu- 
 matism in his fingers. 
 
 As Mr. Sims Reeves informed me that when he was 
 travelling, he always took his own sheets with him, I might 
 have suggested to Mr. W. T. Best that he should always take 
 his table napkins when he travelled.
 
 SIXTY-FOUR YEARS A DOCTOR 123 
 
 MR. HENRY R. BIRD. 
 
 Mr. Henry Bird was the Organist of St. Mary Abbots, 
 Kensington. He was also a very distinguished Pianist. 
 For many years he was the accompanist at the Saturday and 
 Monday Popular Concerts, and some of the distinguished 
 vocalists who came from London to Blackpool refused to 
 enter into an engagement unless they could be accompanied 
 on the piano by Mr. Henry Bird. 
 
 On Whit-Tuesday afternoon, May, 1912, on my way 
 from the Hippodrome oppressed with the heat, in passing 
 through Kensington, I sought a cooler atmosphere in St. 
 Mary Abbots, Kensington. I hoped also to find my nephew, 
 Frederick Gregson Shuttleworth, who was at that time, and 
 had been for more than 20 years, the deputy organist, but 
 who, on the death of Mr. Henry Bird, was appointed his 
 successor. The Verger informed me that Mr. Shuttleworth 
 was having an afternoon off, and that Mr. Bird himself was 
 taking the service. I waited until it had concluded and 
 then introduced myself to Mr. Bird as the uncle of his deputy. 
 He was exceedingly kind to me, told me a good deal about 
 the organ, and said that he would be glad to play a little 
 more for me if I wished him to do so. He then asked me 
 where I was going, and when I said to Kensington Gardens, 
 he replied that he would be glad to go with me. He did so, 
 and afterwards accompanied me to Oxford Street and saw 
 me in the most suitable omnibus to take me to the Euston 
 Hotel. 
 
 I heard nothing more of him until I received a letter 
 in July, 1912, from my nephew, stating that Mr. Bird would 
 pass through Preston in the course of a few days on his way 
 to Blackpool, where he had arranged to conduct an examina- 
 tion in music. I thereupon wrote to invite him to dine with 
 me and sleep here, but he was only able to accept the first 
 part of my proposal, as he had to commence his work at 
 Blackpool at eight o'clock in the morning. It so happened 
 that on the evening fixed for his visit to Blackpool, I had 
 promised to dine with my friend Mr. Galloway, at the Willows, 
 Ashton-on-Ribble, and I knew that he would be very much
 
 124 SIXTY-FOUR YEARS A DOCTOR 
 
 pleased to have Mr. Bird as one of his guests. I therefore 
 announced to Mr. Galloway my intention, and he heartily 
 approved of it. Both he and his friends were delighted with 
 Mr. Bird's company, and what Mr. Bird himself thought of 
 his visit to the Willows is expressed in a letter, of which I 
 am adding a copy to what I have expressed as a very happy 
 reminiscence. As Dr. Sprawson, of Blackpool, was return- 
 ing home in his motor car, he took Mr. Bird with him, and 
 thus added another link to his chain of enjoyment. 
 
 8, LoNGRiDGE Road, 
 
 Earl's Court, S.W., 
 
 lith July. 1912. 
 Dear Dr. Brown, 
 
 On this Sunday afternoon, having a little breathing time, I am 
 anxious to send a few words of acknowledgment and sincere thanks 
 for your great kindness to me on Wednesday. May I assure you how 
 very greatly I enjoyed everything you so kindly planned for me. 
 Those two great institutions in Preston have left a lasting impression 
 on me, and then it was entirely for your sake I was so warmly received 
 in the evening, for I really felt I had no claim to have been the guest 
 at such a distinguished entertainment as Mr. Galloway had provided ; 
 then it was delightful to be taken back to Blackpool in such a speedy 
 and luxurious carriage, so altogether I beg you to accept my grateful 
 thanks, and believe me with sincere esteem. 
 
 Yours most truly, 
 
 (Signed) HENRY R. BIRD. 
 
 GENERAL BOOTH. 
 
 In the summer of 1910 I was requested by the Mayor 
 of Preston to show hospitality to General Booth, from Satur- 
 day night to Monday morning, and I had much pleasure in 
 consenting to do so. The object of his visit was to awaken 
 the interest of the public in the work of the Salvation Army. 
 As I was anxious to make the arrangements for his comfort 
 as complete as possible, I wrote to the Headquarters of the 
 Salvation Army in London for some information in reference 
 to the hours at which he took his meals and the kinds of 
 food which he preferred to have, and any other matters which 
 were regarded as important. The following were the 
 instructions : — 
 
 The General is a vegetarian, and does not take fish, 
 flesh, or fowl in any form. 
 
 In the morning, usually about 8, the General takes
 
 SIXTY-FOUR YEARS A DOCTOR 125 
 
 very crisp toast and butter, with tea and sliced lemon, instead 
 of sugar and milk, which he uses as desired. A small quantity 
 of grated or cream cheese is acceptable also. 
 
 For lunch, at about 12-30, he has a little vegetable soup 
 with asparagus, potatoes, or other vegetable that may be 
 in season, together with crisp Yorkshire pudding occasionally, 
 all of which he prefers at the same time as the soup. 
 
 Before leaving for the afternoon meetings the General 
 likes a cup of tea. 
 
 Directly after his afternoon meeting, usually about 
 4-45 p.m., the General takes tea, bread, and butter, and 
 cream cheese, with mushrooms occasionally, or fried potatoes, 
 as may be convenient. Sometimes a little honey. 
 
 For supper a little bread and butter, some toast, and a 
 jug of hot milk is acceptable, and when apples are not in 
 season, an orange is preferred. 
 
 By way of beverage the General drinks Seltzerwater. 
 
 A quiet and darkened bedroom is very desirable, as his 
 sleep is easily broken, while a soft bed is preferred, if con- 
 venient. 
 
 The officer who accompanies the General will need a 
 separate bedroom as near the one occupied by the General 
 as possible. 
 
 I did not see much of the General during his visit, but 
 I was very much impressed in the short conversations which 
 I had with the " Grand Old Man," and I regarded the 
 opportunity of entertaining him as a great privilege. 
 
 Whatever opinion may be held with regard to the 
 religious side of the operations of the Salvation Army, there 
 can hardly be two opinions as to the enormous value of its 
 philanthropic work. 
 
 Although there has been much difference of opinion 
 in reference to General Booth's methods, there can be no 
 doubt that his work represented a great national force for 
 the moral and spiritual elevation of the people of the world. 
 The Salvation Army has conducted its operations in no 
 fewer than 70 different countries and 42 different languages. 
 Hundreds of thousands of men, women, and children have
 
 126 SIXTY-FOUR YEARS A DOCTOR 
 
 been rescued from sin, misery, and degradation through its 
 instrumentaUty. 
 
 It is interesting to reflect how the Salvation Army grew 
 up, the creation of one man, or rather of a pair of human 
 beings, for the late Mrs. Booth was scarcely less important 
 to its development than was her husband. 
 
 His originality lay in carrying his method not only into 
 the highways and hedges, but into the slums, the homes of 
 the very poor, the haunts of criminals and riff-raff, and in 
 his own special way converting them and changing their 
 mode of life. 
 
 The story of the Salvation Army is one of the most 
 amazing religious movements of modern times. Within the 
 crowded and momentous lifetime of its founder, the Salvation 
 Army has grown from an obscure slum mission in London 
 to an international crusade of social and spiritual evangeliza- 
 tion which has benefited hundreds of thousands of the sub- 
 merged tenth in every civilised nation ; has been appreciated, 
 patronised, and encouraged by monarchs and governors of 
 almost every nation under the sun ; and has undoubtedly 
 done much to arouse the public conscience to the social 
 cancer which lies at the root of society. 
 
 The Salvation Army began in 1865, when one man and 
 his wife, Mr. and Mrs. Booth, took up their stand as street 
 preachers at Mile End Green. 
 
 As General Booth stood with me on my front doorstep 
 waiting for my carriage to take him to the station, a snap- 
 shot was taken of us, and we both came out very 
 well. 
 
 COLONEL CYRIL BOWDLER, C.B. 
 I had the pleasure of entertaining Colonel Cyril W. 
 Bowdler, C.B., on the occasion of his visit to Preston in 
 connection with the Ambulance movement, and I invited 
 a few friends who were interested in that subject, and in 
 music, to meet him. It was most unfortunate that the day 
 fixed for his meeting occurred during the absence of my 
 cook on her holidays. I endeavoured to make up for the
 
 SIXTY- FOUR YEARS A DOCTOR 127 
 
 loss of her services by engaging what is called a " Town's 
 Cook," whose late arrival in the afternoon caused me much 
 anxiety in reference to the punctuality which I wished to 
 observe. T'was sorry to find that my anxiety was quite 
 justified. Having been on the fidgets for an hour and a half, 
 and there was no sign of dinner, one of my musical friends 
 jocularly asked me if they were to expect any dinner that 
 evening ? 
 
 Both my guests and I enjoyed the charming society of 
 Colonel Bowdler, and regretted that it was only for a few 
 hours. 
 
 Colonel Cyril WiUiam Bowdler, C.B., was one of the 
 most interesting personages in connection with Ambulance 
 work. He was born in September, 1839, joined the 8th 
 Hussars in 1864, and on his retirement from the Service in 
 1891 was employed for a few years in the Intelligence Depart- 
 ment. For many years he was Chief Commissioner of the 
 St. John Ambulance Brigade, and he died at Camberley on 
 November 7th, 1918. He was created a C.B. in 1902, largely 
 in recognition of his work in connection with supplying 
 Orderlies in the Boer War. 
 
 Not only was Colonel Bowdler a soldier, but he held a 
 Medical Degree, was a Bachelor of Music, and Doctor of 
 Laws, and he wrote and spoke several languages proficiently. 
 He held successively the appointments of First Deputy 
 Commissioner of the London Department of the St. John 
 Ambulance Brigade, the Chief Commissioner, and Com- 
 missioner for Special Services. He was an important agent 
 in the creation of the Bearer Companies of the Brigade, which 
 as a supplement to the Royal Army Medical Corps, became 
 incorporated on the outbreak of War, and of the Royal Naval 
 Auxiliary Sick Berth Reserve, as a supplement to the medical 
 personnel of the Navy. The latter was so well organised that 
 its mobilisation was completed 24 liours after the outbreak 
 of hostilities. 
 
 Though somewhat reserved in manner, and strict in 
 disciphne, he was a true and charming friend to those who 
 earned his confidence.
 
 128 SIXTY-FOUR YEARS A DOCTOR 
 
 SIR J. F. BRIDGE. 
 
 I made the acquaintance of Sir J. F. Bridge, or 
 Dr. Bridge as he was then, at the house of Mr. Geo. Galloway, 
 Ashton-on-Ribble. His son, Mr. W. W. Galloway, who is 
 now Vice-Chairman of the great Cotton Spinning and Manu- 
 facturing firm of Horrockses, Crewdson & Co., was one of 
 Dr. Bridge's pupils, and is an accomplished organist and 
 pianist. He lives at a beautiful house called The Willows, 
 about 50 yards from Ashton Bank, and his garden was laid 
 out from the designs of Mr. Mawson, whose name is now 
 associated with the building of modem Athens. The WiUows 
 contains a collection of the finest works of Art, a three- 
 manual organ by Lewis, of Brixton, a Steinway pianoforte, 
 a gramophone, and an electrical piano. Mr. Galloway has 
 also a house on Imperial Terrace, Blackpool, between which 
 and the WiUows he travels in one of the finest motor cars 
 on the road. When he was learning the cotton trade at 
 about 16 years of age he had the misfortune to have the 
 second and third fingers of his right hand severely injured 
 by some of the machinery. I made his acquaintance by his 
 coming to my house to have his injuries attended to, and 
 I was afraid both then and afterwards that amputation would 
 become necessary, but I persevered with the simple dressing 
 that I at first adopted, and the fingers made such a good 
 recovery that he has ever since then been able to play the 
 organ and piano without any difficulty whatever. When 
 one bears in mind the- wonderful results which are now 
 experienced from the adoption of the aseptic method of 
 treatment, it is interesting to know that the only dressing 
 which I employed was pieces of lint dipped in cold water 
 and fastened round the finger with a piece of bandage. 
 
 I also had the pleasure of meeting Sir. J. F. Bridge at 
 dinner at Mr. Galloway's, The WlUows, and going with him 
 and his host to the Ashton Wesleyan Church, where he 
 delivered an interesting and amusing account of his inter- 
 view with the committee appointed to revise the Wesleyan 
 Church Hymn Tune Book. There were many entertaining 
 incidents in his address, but I will only mention one. The
 
 SIXTY-FOUR YEARS A DOCTOR 129 
 
 merits of each tune were discussed, and it frequently 
 happened that when Sir Frederick remarked, " Oh ! I don't 
 care for that tune. I think I woiildn't put it in the revised 
 edition," there was a general outcry, " Please don't leave 
 that tune out. It is a great favourite with our friends in 
 the North." I had arranged with Mr. GaUoway to go to 
 London to hear a performance of Sir F. Bridge's Cantata, 
 " Boadicea," by the Highbury Musical Society, but business 
 engagements unfortunately prevented Mr. Galloway from 
 accompanying me. In travelling from London to Highbury 
 I accidentally found myself in the compartment containing 
 Sir F. Bridge, and I was rather startled when he suddenly 
 shouted through the window at the top of liis voice, "Joey! 
 Joey!" It appears that he had recognised on the platform 
 of a roadside station, his friend Mr. Joseph Maas, the eminent 
 tenor, and the incident recalled the Guild of 1882, when I 
 had the pleasure, at the request of Sir Frederick, of entertain- 
 ing Mr. Maas as well as himself. 
 
 During the Guild week in September, 1882, Sir Frederick 
 and I had several visits from Mr. Robert HUton, the principal 
 bass singer of Westminster Abbey, whose valuable services 
 had been secured by the Guild Musical Committee. Mr. 
 Hilton was the guest during his visit to Preston of Mr. Thos. 
 Dilworth, the Steward of Whittingham Asylum. Both 
 Mr. Dilworth and Mr. Hilton in the earlier parts of their 
 careers were employed in the Goods Department of the 
 London and North-Western Railway Co., at Preston, and 
 Mr. Dilworth told me with justifiable pride that he taught 
 Mr. Hilton his notes. Mr. Hilton was, up to the time of his 
 leaving Preston, a member of the Parish Church Choir, and 
 he had previously occupied a similar position at St. Peter's 
 Church. 
 
 My nephew, Frederick Gregson Shuttleworth, who is 
 at present the Organist of St. Mary Abbots, Kensington, 
 was an articled pupil with Sir Frederick Bridge. On Wliit- 
 Sunday, 1914, I went with Dr. Wetton, Organist of the 
 Foundling Hospital, who was also an articled pupil 
 with Sir Frederick, to have tea with him at his house in
 
 130 SIXTY-FOUR YEARS A DOCTOR 
 
 The Cloisters, and we afterwards sat with him in the organ 
 loft during the evening service. We had the pleasure of 
 meeting at the house in The Cloisters, Dr. Alcock, the Organist 
 of the Chapel Royal, and one of the deputy organists of 
 Westminster Abbey, and also Mr. Corney Grain, at one time 
 a well-known entertainer. 
 
 MR. HERBERT BRIERLEY. 
 The St. John Ambulance Association has not a greater 
 friend in Preston than Mr. Herbert B. Brierley. He has 
 been the Honorary Secretary for about 30 years, and he 
 still displays great energy in organising new classes and 
 promoting the success of the Ambulance movement in every 
 possible way. His cheerful countenance is a very valuable 
 asset to him, and is " Like a sunny day which sheds its 
 brightness all around." 
 
 SIR GEORGE BUCHANAN. 
 
 Sir George Buchanan was sent to Preston by Sir John 
 Simon, President of the Local Government Board, in 1862, 
 to investigate an epidemic of typhus fever which occurred 
 during the Cotton Famine. When I was at King's College 
 Hospital I was chnical clerk to Dr. Charles Marchison, one 
 of the greatest authorities on the subject of fever. He had 
 predicted that typhus would occur as a result of the over- 
 crowding and destitution arising from the poverty of the 
 people. I wrote to tell him as soon as the outbreak com- 
 menced, and he was very much pleased with me for doing 
 so. The Corporation of Preston put up a temporary fever 
 hospital. The contagion was so severe that Dr. Ridley, the 
 Medical Officer in charge of this hospital, and 12 nurses 
 died within a very short time of each other. 
 
 Shortly after his arrival in Preston, Sir George Buchanan 
 called upon me, and I went round with him to some of the 
 houses in which the fever cases occurred. 
 
 DR. WILLIAM CAYLEY. 
 
 Dr. William Cayley was a fellow-student with me at
 
 SIXTY-FOUR YEARS A DOCTOR 131 
 
 King's College, London, from 1855 to 1858. When he had 
 obtained his qualifications at the University, he was for 
 some time assistant to Sir William Bowman, the eminent 
 Ophthalmic Surgeon. He afterwards became one of the 
 Physicians to the Middlesex Hospital, and to the London 
 Fever Hospital, Liverpool Road, Islington. He lodged in 
 Queen Square, Bloomsbury, and I in Belgrave Street, King's 
 Cross, Euston Road. We generally walked together until 
 he turned from Red Lion Street, to the left, to Queen Square. 
 After I left London, and up to the time of his death, we 
 occasionally corresponded. In 1893 I stayed with him one 
 night when he lived in Wimpole Street, Cavendish Square, 
 and I twice spent a night with him at Queen's Road,Richmond, 
 I quite agree with every word which was said of him in the 
 obituary notice in the British Medical Journal. He was one 
 of my most highly esteemed friends. 
 
 LIEUT.-COL. CHARD, V. C, 
 
 The Hero of Rorke's Drift. 
 
 I had the pleasure of making the acquaintance of Major 
 Chard at " Greyfriars," the house of Sir Frank and Lady 
 Hollins. They are two of my oldest friends, and I have 
 received great kindness from them, and enjoyed their 
 hospitality on many occasions. Sir Frank is the Chairman 
 of the widely known firm of Messrs. Horrockses, Crewdson 
 & Co., Ltd. Lady Hollins, in addition to receiving other 
 distinctions, was awarded by the King, for her valuable and 
 benevolent work in connection with wounded soldiers, the 
 O.B.E. Lieut. -Col. Chard obtained the V.C. for his vafiant 
 conduct during the Zulu War in 1879. 
 
 When he was a Lieutenant in the Royal Engineers, he. 
 Lieutenant Bromhead, of the 24th Regiment, and Lieutenant 
 Adendorf, of the Natal Contingent, with about 100 men 
 valiantly defended the position of Rorke's Drift, when it 
 was attacked by 3,000 to 4,000 Zulus. They held the position 
 from five o'clock in the afternoon until daylight the following 
 morning, when Lord Chelmsford arrived with relief forces, 
 and they retired. As the three lieutenants had heard of
 
 132 SIXTY-FOUR YEARS A DOCTOR 
 
 the disaster at Isandula, where there had been a destruction 
 of almost the entire 24th Regiment, they felt certain that an 
 attack on their little force was imminent, and they threw 
 up a barricade of empty meal bags and biscuit tins. In this 
 they were helped by the Chaplain, the Rev. George Smith, 
 and many people were disappointed that he was not also 
 awarded the Victoria Cross. Lieut. -Col. Chard resided at 
 Simmer's Hotel, Fulwood, from 1890 to 1896. For several 
 winters, commencing 1881-1882, he inspected all examina- 
 tions under the Science and Art Department, Kensington. 
 Lieut. Col. Jolly often accompanied him to the Convent 
 School, 22, Winckley Square, and also the one at Larkhill. 
 He was always thoughtful and kind, but most conscientious, 
 and insisted on all regulations being strictly carried 
 out. 
 
 An amusing incident occurred in connection with Lieut. - 
 Col. Chard when he was living at Fulwood. One Sunday 
 he was attending morning service at a neighbouring Church, 
 when a Mr. Stott, who was sitting with his little son in a 
 pew a few feet further back, pointed to the Major and said 
 in a low voice, " That is the hero of Rorke's Drift." The 
 child remarked, but not in a whisper, " Father, I always 
 thought that a hero was a very big man." This incident 
 evidently interested some of the members of the congregation 
 who heard the little boy's comment, and it certainly attracted 
 the attention of the Lieut. -Col., who probably blushed, as 
 he was a very modest and unassuming little man. 
 
 MADAME BELLE COLE. 
 About 30 years ago, when Madame Belle Cole was taking 
 part in a concert at Preston, she was the guest of my sister 
 and myself for the night. We invited a few musical friends 
 to meet her at supper, and she delighted us beyond descrip- 
 tion by her rendering of Sullivan's " Lost Chord," in my 
 drawing room. It was before the days of gramophones, 
 and I feel what a pleasure it would have been to us if we 
 could have preserved a record on that useful and popular 
 instrument, of her magnificent contralto voice.
 
 SIXTY-FOUR YEARS A DOCTOR 133 
 
 MR. J. D. 
 
 Mr. J. D. was for many years Secretary to the Joint 
 Railway Companies at Preston, and it was he who first 
 provided me with passes to Fleetwood and Blackpool for 
 the Preston Infirmary Nurses. He lived to^be 90 years of 
 age, which seems a very extraordinary circumstance when 
 it is borne in mind what his ordinary habits were. 
 
 I one day received a letter from a patient of mine who 
 sailed to Algiers from Marseilles. In a letter which he wrote 
 to me on his arrival at Marseilles, he said, " On the boat was 
 Mr. J. D., of Preston. He is the most extraordinary man 
 I ever met. He never had a cigar out of his mouth except 
 when he was eating, and he appeared to me to sample 
 every species of liquor there was on board the ship." 
 
 THE DERBY FAMILY. 
 My first recollection of the Derby family dates from 
 Wednesday, September 3rd, 1862, when Edward Geoffrey 
 Stanley, the 14th Earl, presided at the dinner of the North 
 Lancashire Royal Agricultural Society. The dinner was 
 held in a large tent in Chapel Walks, and there were about 
 1,700 persons present, including a large number of farmers, 
 upon whom the noble Earl impressed the importance of the 
 application of manure to the land, and he emphasised its 
 value in the short sentence, " Muck is money." In their 
 excitement many of them frequently repeated the emphatic 
 sentence, but not in a whisper. The weather during the 
 Guild week of 1862 was most unpropitious, for it rained 
 heavily nearly every day. The tent in which the dinner 
 was held was not waterproof, and the rain literally poured 
 through the canvas at times, causing much discomfort. My 
 experience was a most unpleasant one. The view of Lord 
 Derby was intercepted by the umbrella of a Dr. Broughton, 
 who sat near me, and after frequently shouting in vain, " Put 
 that umbrella down," some officers from Fulwood Barracks 
 began to pelt it with little round rolls of bread which had 
 attained the consistence of bread poultice. These little masses 
 of softened bread on hitting the imibrella glanced off on to my
 
 134 SIXTY-FOUR YEARS A DOCTOR 
 
 new frock coat and completely spoiled its new appearance. 
 
 It was a great pleasure to me to hear his addresses, 
 as I had often heard the Earl of Derby spoken of as the 
 Rupert of debate, on account of his forensic eloquence. 
 After the dinner the Earl of Derby delivered several addresses 
 " replete with eloquence, good sense, and practical wisdom." 
 One of the principal musical features of the day was a band 
 playing " Stanley for Ever." The music I need scarcely 
 say was not composed by Mendelssohn, Sullivan, or any 
 other distinguished musician. 
 
 On June 3rd, 1873, I was at a luncheon given by the 
 Mayor, Mr. Miles Myers, at the Guildhall, to the 15th Earl 
 of Derby, son of the above, and uncle of the present Earl. 
 The occasion was the unveiling of the Statue of the 14th 
 Earl of Derby, in Miller Park, by Lord Winmarleigh. On 
 the day the statue of the Rupert of debate in Miller Park 
 was unveiled, a friend of mine met a man in Fishergate and 
 asked him what the excitement in the streets was about, 
 and his reply was, " He did not know, but he had been told 
 that ' It was the unvealing of the Statute.' " 
 
 At the Guild of 1902, the 16th Earl, father of the present 
 Earl, lived during the week at number 8, Winckley Square, 
 and I have met him and had a chat with him when he was 
 taking his early morning walk between seven and eight 
 o'clock. Shortly after the Guild I had the honour of invest- 
 ing on behalf of the Preston Corporation the Dowager Countess 
 with the first Mayoress's Chain, the object of which was to 
 place on record the kindly com-tesy and hospitality which 
 she and her husband had extended to the inhabitants of 
 Preston during the Guild Mayoralty of 1902. At a later date, a 
 number of Prestonians, of whom I was one, were invited to 
 visit Knowsley, and we had a very kind reception and hearty 
 welcome from the Earl and Countess. We had the privilege 
 of inspecting the house and gardens. One of the attractions 
 which had been provided was an orchestra composed entirely 
 of ladies. 
 
 On Saturday, April 19th, 1913, I was there when the 
 present (the 17th) Earl of Derby opened the new Grammar
 
 SIXTY-FOUR YEARS A DOCTOR 135 
 
 School in Moor Park Avenue. I received the whole of my 
 education, except the medical portion of it, at the old 
 Grammar School in Cross Street, and it was very interesting 
 to me to hear the Headmaster say that it was an established 
 fact that the 12th Earl of Derby, who was born at Patten 
 House, Preston, on the 12th September, 1752, received his 
 early education at its predecessor, the old Grammar School, 
 in Stoneygate. 
 
 I have not forgotten the memorable wish which the noble 
 Earl expressed at the conclusion of the Preston Guild Festival, 
 namely, " That the connection between Preston and his 
 family might be preserved in the same manner as it had 
 been hitherto, by mutual respect, mutual confidence, and 
 mutual love." 
 
 Colonel the Honourable George Stanley made himself 
 known to me by calling to remind me that he was a candidate 
 for the representation of Preston in Parliament, and, during 
 the last few years I have frequently enjoyed his society at 
 the 9th November Mayoral and Aldermanic luncheon. I 
 first met Lady Beatrix Stanley at the annual meeting at 
 the Cross Deaf and Dumb School, next at the Conservative 
 Working Men's Bowling Green, at Fulwood, and the third 
 time at the house of Mr. W. W. Galloway, The Willows, 
 Ashton-on-Ribble. I am looking forward to the pleasure 
 of seeing her again during the Guild week, if not before. 
 
 I was introduced to the present Lord and Lady Stanley 
 when I was presented to the Prince of Wales on June 21st, 
 1921. 
 
 The Hon. Arthur Stanley, M.V.O., M.P., as he then 
 was, now the Hon. Sir Arthur Stanley, G.B.E., C.B., M.V.O., 
 M.P., was installed Right Worshipful Provincial Grand 
 Master for the Western Division of Lancashire, in the Public 
 Hall, Preston, on Monday, October 10th, 1910. I was 
 present on this occasion, and regarded it as a very impressive 
 ceremony. 
 
 SIR DYCE DUCKWORTH. 
 
 I find that I began to correspond with Sir Dyce Duck- 
 worth in 1902, with reference to a patient, but I did not
 
 136 SIXTY-FOUR YEARS A DOCTOR 
 
 personally make his acquaintance until I met him at the 
 Royal College of Physicians, when I was admitted to the 
 Fellowship, May 14th, 1908. 
 
 I had heard a great deal of his brother, the Rev. Canon 
 Robinson Duckworth, at a house, 55, Hamilton Square, 
 Birkenhead, and also from my sister, Mrs. Shuttleworth, 
 of HaU Road, St. John's Wood, who was a member of his 
 congregation. 
 
 I was therefore all the more interested when I had the 
 pleasure of making Sir Dyce's acquaintance. 
 
 In October, 1910, I received the following letter from 
 him : — 
 
 I have been interested in reading about your civic honour, and 
 venture to add my warm congratulations to you herewith. As I am 
 a Lancastrian, I know what heartiness and energy are, so I can picture 
 the fervour which characterised the feeUngs of your fellow-townsmen 
 last Saturday. These particular honours seldom come to members 
 of our Profession. Certainly less often than they might well do. 
 
 In 1912 I had another letter from him in which he says : — 
 
 I am much obliged by your Uttle book about Lytham, Blackpool, 
 and St. Annes. I have a high opinion of the air and climate of that 
 coast. Londoners do not know of its beneficial quahties; they think 
 Margate and Southend unbeatable. 
 
 SIR W. FERGUSSON. 
 
 When I went to King's College in 1855, Sir W. Fergusson 
 was in the height of his fame, and the brilliancy with which 
 he performed an amputation or a lateral lithotomy, or the 
 delicate manipulation with which he operated for cleft palate, 
 attracted a great many visitors to his theatre. Amputations, 
 however, were becoming less and less frequent, as the con- 
 servative method of excising the diseased joint instead of 
 removing the limb was becoming more generally adopted. 
 Indeed, Sir W. Fergusson and Mr. Syme, of Edinburgh, 
 were two of the chief pioneers in this branch of operative 
 surgery. This was, of course, 12 or 15 years before the 
 introduction of antiseptics, but since this great revolution 
 in treatment, excisions have been more frequently under- 
 taken and with more satisfactory results. But just as 
 amputation has been superseded in suitable cases by excision.
 
 SIXTY-FOUR YEARS A DOCTOR 137 
 
 SO excision is superseded by arthrectomy. In this operation, 
 instead of sawing off layers of bone, diseased foci only are 
 gouged out, and the resulting cavities are disinfected by 
 carbolic acid and packed with sterilised iodoform. Influenced 
 by Sir William's great reputation, and attributing to him 
 a power which he did not possess, many patients came to 
 see him under the impression that he could restore to its 
 normal flexibility and usefulness, in the course of a few days, 
 an arm which had been fractured, and from which the splints 
 had only just been removed. He always treated these 
 people with great kindness and sympathy, and assured them 
 that, in due course, the limb would be as good as it was 
 before the accident. He also instructed them to come and 
 see him again in three months, if, by that time the limb had 
 not recovered its normal flexibility and usefulness. Knowing 
 however, as he did, that most of these patients would not 
 be satisfied unless they had " something to take," he almost 
 invariably told his house surgeon to order them five grains 
 of compound galbanum pills three times a day. 
 
 I had not seen Sir W. Fergusson after I left King's 
 College in December, 1858, until I was asked to give chloro- 
 form for him whilst he removed a mammary tumour from 
 a lady who was a patient of the late Dr. Hammond. 
 
 After the operation I dined with him at Dr. Hammond's 
 house, and we both went to the station with him and saw 
 him off to London by the limited mail at 10-40. 
 
 DR. WILSON FOX, 
 Physician to Queen Victoria. 
 On Wednesday morning, April 27th, 1887, I received 
 a telegram from Sir William Roberts, of Manchester, asking 
 me to see a patient with him at the Park Hotel, Preston, 
 at four o'clock in the afternoon. About three o'clock a 
 page boy came running without his cap to my house with 
 a message for me to go at once to the Park Hotel to see a 
 visitor who was very ill, and had fallen on the bedroom 
 floor. On my arrival I found that the visitor was Dr. Wilson 
 Fox, whom Sir William Roberts had wished me to see with him.
 
 138 SIXTY-FOUR YEARS A DOCTOR 
 
 Dr. Fox had arrived in Preston on Tuesday evening, 
 having joined Mrs. Fox at Bristol the same day. At 
 Birmingham he walked about for half-an-hour. He made 
 no complaint of not feeling well, but he remarked that he 
 was glad to get away from the strain which he had under- 
 gone at his brother's deathbed. He conversed with Mrs. 
 Fox until eleven o'clock, still giving no indication of not 
 being well. Shortly before eight the following morning, 
 when Mrs. Fox went to his bedroom, he told her that his 
 temperature was 102° Fah., which fact she verified for her- 
 self. He said also that he had a slight rigor during the night, 
 and thought he was gouty and rheumatic. Sir W. Jenner 
 visited him on Friday, April 29th, and saw him in consulta- 
 tion with Sir Wm. Roberts. He was exceedingly weak, 
 and Sir W. Jenner remained at the Park Hotel all night, 
 but he stipulated that I must also sleep in the hotel and 
 visit Dr. Fox if called up to do so, as he wished to remain 
 in bed undisturbed. The pneumonia appeared to be running 
 its ordinary course until Saturday morning, when shortly 
 after ten o'clock great prostration occurred, and suddenly 
 his breathing became much hurried, and he suffered from 
 severe pain in the lower part of the right side. 
 
 Dr. Russell Reynolds, who had arrived in succession 
 to Sir Wm. Jenner, was with him as soon as possible after 
 the prostration had set in, and found that the pain was not 
 pleuritic, but muscular, and that the chief trouble at that 
 time was cardiac weakness. On the arrival of Dr. Russell 
 Reynolds and Dr. Arkle, one of Sir Wm. Jenner's old pupils, 
 I went away to Brighton in charge of an important Alderman, 
 who was very much out of health, and would not leave home 
 unless I went viith him. On Monday morning at about 
 ten o'clock, quite suddenly the dyspnoea increased, and fine 
 bronchial rales could be heard on both sides of the chest. 
 Prostration was extreme, and from this he never rallied, 
 although taking nourishment and stimulants easily and 
 freely until four o'clock on Tuesday morning, when, after 
 a few minutes pallor, but in perfect possession of aU his 
 intellectual faculties he suddenly passed away. His second
 
 SIXTY-FOUR YEARS A DOCTOR 139 
 
 wife, the widow of Captain Burgoyne, R.N., the Commander 
 of the ill-fated " Captain," survives him. 
 
 Mrs. Fox gave me as a memento a diamond pin, which 
 had been presented to Dr. Fox by Que*i Victoria, and was, 
 therefore, to be prized very highly. 
 
 A memorial tablet was erected in Preston Parish Church 
 by his widow and sons, and the inscription on it was : — 
 
 To THE Honour and Glory of God, 
 
 And in Memory of 
 
 Wilson Fox, M.D., F.R.S., 
 
 Physician-in-Ordinary to Queen Victoria. 
 
 Born 2nd November, 1831. 
 
 Passed into Rest at Preston, 
 
 3rd May, 1887. 
 
 This screen was presented to the Parish Church of St. 
 John, Preston, and dedicated on the Feast of St. Luke, the 
 Evangelist, 1903. 
 
 Dr. Fox was in the habit of placing his beautiful house 
 at Rydal at the disposal of the Bishop of Bedford for the use 
 of the invalided East End clergy and their families. 
 
 MR. REGINALD HARRISON AND SIR THOMSON 
 WALKER. 
 
 After the operation of Prostatectomy, I invited Mr. 
 Harrison and Sir Thomson Walker to spend the weekend 
 with me at Preston. When they came shortly afterwards, 
 I invited some of the Preston medical men on the Saturday 
 evening to meet them at dinner, and some of the others on 
 the Sunday evening at supper. 
 
 On the Sunday afternoon I took them to Lytham, St. 
 Annes, and Blackpool, and like others who have visited 
 those three places, they took away with them a very favour- 
 able impression, and desire to visit them again. 
 
 SIR H. F. HEATH, K.B.E. 
 When I made his acquaintance he was Assistant 
 Registrar at the University of London. He now holds a
 
 140 SIXTY-FOUR YEARS A DOCTOR 
 
 very important position under the Board of Education. 
 He and his wife stayed with me in Winckley Square for a 
 few days on their way from Scotland to London. I took 
 them to see the Infirmary, the Harris Free Library and 
 Museum, the Harris Orphanage and the School of Domestic 
 Science. They were very much pleased with all of them. 
 Several years afterwards Sir H. F. Heath paid me a second 
 visit, for one night only. On Whit-Sunday, 1919, I spent a 
 very pleasant afternoon with Sir H. and Lady Heath at 
 Ruislip, their beautiful country house. 
 
 SURGEON-MAJOR G. A. HUTTON, J.P. 
 (Late the Rifle Brigade ; Hon. Organising Commissioner, 
 St. John Ambulance Association.) 
 Generally when he has been sent to Preston by the 
 St. John Ambulance Association to examine the local 
 classes he has been my guest, and owing to his long and 
 intimate association with the movement, his conversations 
 on the subject were very interesting. He gave me a full 
 account of early ambulance work in West Yorkshire, 
 Lancashire, and the Isle of Man. 
 
 MR. R. C. IRWIN. 
 
 Mr. Irwin, who has recently been appointed Secretary 
 of the London and North-Western Railway Company, was 
 previously Secretary of the Lancashire and Yorkshire 
 Railway at Hunt's Bank, Manchester. During a con- 
 siderable portion of my long association with the Railway 
 Company, he was a kind and considerate friend. 
 
 For over 30 years it was my custom to give from 40 
 to 50 nurses of the Preston Royal Infirmary an annual trip 
 to Fleetwood and Blackpool. I always arranged the trip 
 on two days nearest to the longest day, when it was high 
 water at Fleetwood about noon. Mr. Irwin was good 
 enough to supply me with free passes for them, and in the 
 envelope enclosing these was generally included a note 
 stating that he had sent instructions aU along the line that 
 Dr. Brown's nurses should have every attention. At
 
 SIXTY-FOUR YEARS A DOCTOR 141 
 
 Fleetwood the nurses had the privilege of inspecting the 
 large Belfast steamers, and they were also for several years 
 taken for a two hours' sail in the tugboat. As some of 
 the nurses, however, were unable to enjoy their lunch on 
 their return from the sea, I thought it desirable to dispense 
 with this form of entertainment. They had lunch at 
 1 o'clock at the Railway Refreshment Rooms at Fleetwood, 
 and at 2-30 they went on to Blackpool and spent the 
 remainder of the day there, had tea at the Talbot Road 
 Railway Refreshment Rooms, and returned to Preston by 
 the 10-30 train. In Blackpool so many sources of amuse- 
 ment were provided for them that they had a difficulty 
 in deciding which to choose. 
 
 In mentioning the London and North-Western Railway 
 Company, I must not fail to acknowledge the kindness and 
 attention which I received from three officials in the 
 Euston Station Offices — Mr. J. Burden, Mr. T. Burfitt and 
 Mr. T. Hill. There was seldom a year before 1914 when 
 I did not pay a visit to London. On each occasion when 
 I returned to Preston, one of them secured a seat for me 
 in the dining car, and one or all of them came to the station 
 to see me off. 
 
 MR. THOMAS CARR JACKSON. 
 
 Mr. Thomas Carr Jackson was one of the surgeons to 
 the Royal Free Hospital, Gray's Inn Road, London. He 
 lived in the Euston Road, at the left-hand corner of Belgrave 
 Street, in a house which was pulled down along with all the 
 houses on the left side of Belgrave Street a few years ago. 
 I believe that his father and my father were friends, but 
 I know that he was a great friend to me. 
 
 When I went with my father to London in 1852, on 
 the occasion of his being admitted an Honorary Fellow of 
 the Royal College of Surgeons of England, we stayed at 
 Mr. Jackson's house. I was also his guest in 1853, when 
 I went up to London to undergo an examination in Classics 
 and Mathematics at the Apothecaries' HaU, and also in 
 1855, when I passed the Matriculation Examination at the
 
 142 SIXTY-FOUR YEARS A DOCTOR 
 
 University of London. When I went to London in 
 October, 1855, to commence my medical curriculum at 
 King's College, Mr. Jackson kindly secured lodgings for me 
 at 14, Belgrave Street. 
 
 During the whole of my residence as a medical student 
 in London, I received great kindness and hospitality from 
 him, and after I had commenced practice in Preston, he 
 took a great interest in my welfare and success. 
 
 SIR WILLIAM JENNER. 
 
 I first saw Sir William Jenner in November, 1861, 
 when I was undergoing my examination for the second 
 M.B. degree at the University of London. He asked me 
 how I was getting on with my papers, and spoke a few kind 
 and encouraging words to me. 
 
 I next saw him in 1886, at the laying of the foundation 
 stone of the Exhibition Hall on the Thames Embankment 
 by Queen Victoria. 
 
 The second interview with him was at the Park Hotel, 
 Preston, when he came to visit the late Dr. Wilson Fox, 
 during his fatal illness. 
 
 He invited me into his room, and whilst he sat on the 
 edge of the bed, I had a pleasant chat with him. 
 
 LIEUT.-COL. T. R. JOLLY, V.D., J.P., M.B.E. 
 
 I cannot remember exactly how long I have had the 
 pleasure of Colonel Jolly's acquaintance, but I do know 
 that he is one of my oldest and most highly esteemed friends. 
 
 For many years I have been associated with him in 
 connection with the Harris Orphanage, the Harris Council, 
 the Harris Institute, and the School of Domestic Science 
 in Glover's Court. The able manner in which he has dealt 
 with all details connected with these institutions has 
 surprised and gratified the members of the respective 
 Committees. His power of organisation is something 
 wonderful, and without it he could not possibly discharge 
 satisfactorily his many duties. 
 
 For his long connection with the Preston Volunteer
 
 SIXTY-FOUR YEARS A DOCTOR 143 
 
 Artillery he was awarded the V.D. He has displayed a 
 patriotism which has been the admiration of his fellow 
 townsmen. He acted as chief Military Representative for 
 Preston and District, for which he was also awarded the 
 British Empire decoration by our present King George V. 
 
 During the last few years he has frequently taken his 
 seat on the local Bench at the Police Court. His well- 
 balanced judgment has been of great value and assistance 
 to his brother magistrates. 
 
 During my recent illness he has constantly visited me, 
 and given me much consolation and encouragement. 
 
 As President of the Harris Orphanage Committee, it 
 gives me much pleasure to say that it would be impossible 
 to find a more efficient Governor than Colonel Jolly, or 
 one who considers more the welfare and happiness of the 
 officials and children. 
 
 DR. T. N. KELYNACK. 
 
 I was introduced to Dr. Kelynack by the late 
 Dr. Dreschfeld at Manchester in 1899, and received very 
 valuable instruction from him in connection with Dr. 
 Dreschfeld's patients in the Manchester Royal Infirmary. 
 
 Wlien he was physician-in-charge of the Mount Vernon 
 Hospital for Tuberciilosis at Northwood, he and his wife very 
 kindly invited me to spend a night there, and I was much 
 impressed with what I may term the palatial character of the 
 establishment. 
 
 When Dr. Kelynack, as general medical adviser of the 
 National Children's Home and Orphanage, comes to examine 
 the children at the Lancashire branch of this great Institu- 
 tion, at Edgeworth, near Bolton, he generally spends the 
 week-end with me, and the comparison of our experiences 
 during the interval between 1899 and the day of our inter- 
 view is a very delightful occupation. 
 
 DR. EDWARD LIVEING. 
 Dr. Edward Liveing, brother of Dr. R. Liveing, was 
 also educated at King's College, London, but he had left
 
 144 SIXTY-FOUR YEARS A DOCTOR 
 
 before I went there. He was the Registrar at the Royal 
 College of Physicians for many years, and it was always 
 a great pleasure to me to have a chat with the dear old man. 
 On August 4th, 1912, I had a letter from him in which 
 he said that he had been staying for a few days with his 
 brother, a Fellow of St. John's College, Cambridge, and 
 
 We spent one afternoon in paying a surprise visit to the Research 
 Hospital in which you had generously interested yourself. Dr. Strange- 
 ways was most kind in receiving us, and showed us all over it, explain- 
 ing its many and excellent provisions for research purposes. His 
 energy and enthusiasm are delightful. I thought the situation good, 
 and the designing and construction of the building and its equipment, 
 admirable. We saw a good many of the patients, and Dr. Strange- 
 ways and his lady assistant were good enough to give me many 
 interesting bits of information with respect to several of the cases. 
 The wards are most homehke and inviting, and the patients appeared 
 as happy in their surroundings as the circumstances of their maladies 
 would permit. I am thankful not to be suffering from Rheumatoid 
 Arthritis, but if I were I should be only too thankful to be taken in 
 there. I have four grandsons who have joined the New Army. 
 
 He concludes his letter with some lines which he 
 recommends me to copy : — 
 
 If the tide is running strong, keep on pulling. 
 If its Winter or it's May, keep on pulling. 
 If you can't see e'en a ray. 
 The sun is bound to shine some day. 
 It's got to come fore long your way, 
 Keep on pulling. 
 
 DR. ROBERT LIVEING. 
 
 Dr. Robert Liveing was a prominent member of the 
 group of four King's College students, which consisted of 
 Dr. Easton, Dr. William Cayley and myself. Previous to 
 coming to King's College he was at Christ's College, Cam- 
 bridge, where he was on intimate terms with two of my 
 brothers who were undergraduates at the same time, and at 
 the same college. 
 
 After he had taken his degree he was appointed one 
 of the physicians of the Middlesex Hospital, and devoted 
 himself especially to the study and treatment of diseases 
 of the skin. He practised for many years as a specialist 
 in this department in Manchester Square. A few years
 
 SIXTY-FOUR YEARS A DOCTOR 145 
 
 before he died, his eyesight failed, and as a result of a 
 paralytic affection he was altogether confined to bed. 
 
 It is an interesting coincidence that the elder of my 
 brothers, who was with him at Christ's College, Cambridge, 
 became Vicar of Nayland, in Surrey, which was Dr. Liveing's 
 native place. 
 
 In December, 1910, Dr. Liveing wrote to tell me that 
 Mr. Arnold Lawson had operated on his eye for cataract 
 last July, with a good result, and he can now read, wliich 
 he had not been able to do for the past few years. 
 
 Some little time after the operation on his eye he 
 wrote : — 
 
 I have only one eye. It keeps fairly good since Arnold Lawson 
 operated on it for Cataract. The chief trouble is that one cannot 
 in the least judge of distances, and cannot walk out in the streets 
 with any safety. Still it is a great thing to be able to see to read after 
 being quite blind. 
 
 A few years previously he wrote : — 
 
 I used to sit near your brother Richard in Hall at Christ's College, 
 Cambridge. He was in the next year to me, the year above. 
 
 Alluding to a mutual friend, he says : — 
 
 Cayley is very well. His time is just up at the Middlesex Hospital, 
 so he will retire this Autumn. He is about to give up practice, and 
 is going to live at Richmond, in Surrey, if he can get rid of his house 
 in Wimpole Street. 
 
 In another letter he writes : — 
 
 My son, Captain Charles Liveing, R.A., will shortly be moved 
 from Woolwich to Preston. He is just going to be married. I shall 
 be much obliged if you can find out for him if there is any hotel near 
 the Royal Artillery Barracks ? Are there any good furnished lodgings 
 near the Barracks ? 
 
 He writes on January 3rd, 1915 : — 
 
 My son, whom you may remember, is now Major, and he has got 
 the D.S.O. and the Cross of the Legion of Honour. (The highest 
 cross). I have had a series of fits, and have been confined to my bed 
 since April last, having lost all power in my legs, and much in my 
 arms. My two nurses get me out of bed daily, but with difficulty. 
 
 SIR JAMES MACKENZIE. 
 The morning after the conversazione at the Royal 
 College of Physicians, I met Sir James Mackenzie by
 
 146 SIXTY-FOUR YEARS A DOCTOR 
 
 appointment at the London Hospital, Whitechapel. At that 
 time he was carrying on a very important series of 
 investigations in connection with the subject of diseases 
 of the heart. He had a specially trained band of assistants, 
 who were making observations on pulse, temperature, and 
 other symptoms during the twenty-four hours, and keeping 
 an accurate record of their observations, and especially with 
 reference to the effect of Therapeutic agents. 
 
 The collection of electrical appliances was extremely 
 interesting, and would have been much more so if I had 
 been more intimately acquainted with the science of 
 electricity. 
 
 SIR MORELL MACKENZIE 
 
 Physician to the German Emperor Frederick. 
 
 When I was a student at King's College, London, from 
 1855 to 1858, Sir Morell Mackenzie was receiving his 
 medical education at the London Hospital, Whitechapel. 
 We both attended tutorial classes conducted by Dr. John 
 Langdon Haydon Down, who subsequently became medical 
 superintendent of the Asylum for Idiots at Redhill, Reigate, 
 Surrey. When Sir Morell Mackenzie had obtained his 
 licence to practise, he devoted himself entirely to the treat- 
 ment of diseases of the throat, and obtained a great repu- 
 tation by his dexterity in the use of the laryngoscope. This 
 instrument was introduced into London by Dr. Czermak 
 in 1862. It is now very extensively used all over the world. 
 Sir Morell Mackenzie soon acquired a very extensive 
 practice, and people who called at his house to consult him 
 sometimes found his rooms so full that patients were sitting 
 on the front staircase. When I was in London in Septem- 
 ber, 1865, undergoing my examination for the membership 
 of the Royal College of Physicians, one of my fellow can- 
 didates was Dr. Balthazar Walter Foster, of Birmingham, 
 who was a friend of the late Mr. Gladstone. It appears 
 that he was staying with Sir Morell Mackenzie and mentioned 
 to him that a man named Brown, of Preston, was also up 
 for examination. On hearing this Sir Morell Mackenzie 
 instructed Sir Walter Foster to invite me to dine with him
 
 SIXTY-FOUR YEARS A DOCTOR 147 
 
 at his house in Weymouth Street, Portland Place. I was 
 
 glad to accept his invitation, and spent a very pleasant 
 
 evening in his company. Sir Morell Mackenzie afterwards 
 
 acquired a world-wide notoriety among German and British 
 
 medical men by his attendance on Frederick, Emperor of 
 
 Germany, father of the demon who was the cause of so 
 
 much sorrow and suffering during the recent war. Although 
 
 he was no doubt overjoyed when he was called in to attend 
 
 the Emperor, circumstances occurred which probably made 
 
 him wish that he had never had anything to do with the 
 
 case. 
 
 In Sir Morell Mackenzie's account of the illness of the 
 
 German Emperor, he says : — 
 
 I was treated with contempt, jealous j^, and suspicion by the 
 German Professors, who schemed against me both before and after 
 the death of the Emperor. My hfe was threatened if I walked down 
 Unter den Linden, and I was vilified with false accounts by a " reptile 
 Press," inspired by the German Professors themselves. 
 
 The Emperor died at Potsdam, June 15th, 1888, and 
 Sir Morell was with him at San Remo in November, and 
 again in December of 1887, and again in January, 1888. 
 Afterwards, at Charlottenburg, and on to Potsdam on the 
 1st of June, where Mackenzie was in attendance until a few 
 days after his death. He was in attendance on and off 
 from May 20th, 1887, to June 15th, 1888. 
 
 DR. HENRY MAUDSLEY. 
 I made the acquaintance of Dr. Maudsley in October, 
 1855, when I went to London to commence my Hospital 
 education at King's College. I took a letter of introduction 
 to him from his brother William, who was an articled pupil 
 with Mr. Barnes, a Chemist in Fishergate, Preston. I 
 occasionally went to see him when he was house surgeon 
 to Mr. Richard Quain at University College Hospital, and 
 I remember that on one of my early visits I found him in a 
 semi-reclining position on a couch making notes from Law- 
 rence on ruptures. He was at that time preparing for the 
 second M.B. examination at the University of London, 
 which he passed in 1856, obtaining the Scholarship and Gold
 
 148 SIXTY-FOUR YEARS A DOCTOR 
 
 Medal in Surgery. After this success he was disposed to 
 practice pure surgery, but he subsequently decided to give 
 his attention to mental disease, and I visited him when he 
 was at Brentwood, in Essex, and also the Royal Manchester 
 Lunatic Hospital at Cheadle. Although we occasionally 
 corresponded, I did not see him again until he surprised 
 me by calling at my house. He spent the greater part of 
 the next day with me, and I took him to two institutions 
 in which I am much interested, the Preston Royal Infirmary 
 and the Harris Orphanage. I also took him to spend a few 
 hours at Blackpool, which interested him very much, as 
 he had heard a great deal about its popularity, and he was 
 not surprised at its being such a favourite seaside resort. 
 Both in his letters and in conversation he expressed his 
 indignation with the London County Council on account of 
 their delay in making use of the £30,000 which he gave them 
 for the erection of a hospital for the treatment of the early 
 stage of mental disorder, in order, if possible, to prevent 
 the necessity arising of sending a patient to an Asylum. 
 It is a sad reflection that owing to the delay on the part of 
 the London County Council he died before his wishes were 
 carried out. Dr. Maudsley took a great interest in the 
 candidates who were successful in gaining exhibitions, 
 scholarships, and gold medals at the University of London 
 and especially in those who were educated in University 
 College Medical School. Although he was fond of reading 
 monographs, he told me of some successful candidates who 
 did not go beyond the ordinary text books, and he mentioned 
 more than once to me the name of Dr. George Buchanan, 
 who ultimately became head of the Local Government Board 
 Medical Department, in succession to Sir John Simon. One 
 or two more reminiscences of Dr. Maudsley are worth 
 recording. 
 
 When I was working very hard for my first M.B, 
 examination at the University of London, he called one 
 afternoon at my lodgings, 14, Belgrave Street, King's Cross, 
 when I had gone for a walk. He asked the maid for half a 
 sheet of paper, and on it he wrote : —
 
 SIXTY-FOUR YEARS A DOCTOR 149 
 
 That a man whose only object is to kill time should be wandering 
 about at this time of the day is not a matter for surprise, but that one 
 who is on the eve of a most formidable examination, which will tax 
 his powers to their utmost capacity, should be idhng away as if they 
 were of no value the few precious hours which remain to him, cannot 
 but excite in the mind of one who takes a great interest in his welfare 
 a feeling of the most profound and sorrowful regret. 
 
 He left this on the table unenclosed in an envelope. 
 
 A few years before he died I mentioned in one of my 
 letters several incidents which occurred when he was Mr. 
 Richard Quain's House Surgeon at University College 
 Hospital. In his reply, which was an open post card, he 
 said : — 
 
 A man who has such a memory for detail as you appear to have 
 ought to be buried in his back garden. 
 
 MR. E. W. MELLOR. 
 In 1905 I received an invitation from Mr. Mellor to be 
 present at the opening of a new Operating Theatre in the 
 Lytham Cottage Hospital, of which he was the President. 
 I afterwards had luncheon at his house, Fair Lawn, Lytham, 
 where I met Canon Hawkins, the Vicar, and several other 
 Lytham friends. This was the commencement of a valuable 
 friendship between me and Mr. and Mrs. Mellor. Since then 
 I have been a frequent visitor at Fair Lawn, and enjoyed 
 the society of Mr. and Mrs. Mellor, and hearing and playing 
 upon their chamber organ. When I opened the Research 
 Hospital at Cambridge, Mr. Mellor did me the honour of 
 attending the ceremony. Mr. and Mrs. Mellor have been 
 extensive travellers, and Mr. Mellor has preserved interest- 
 ing records of their travels in photographs taken by himself. 
 He also possesses a valuable cinematograph. He has afforded 
 much pleasure to many people by giving exhibitions and 
 lectures. Mr. and Mrs. Mellor were my guests for the night 
 at the opening of the Grammar School Organ at Moor Park 
 Avenue, and distribution of prizes by Dr. James, Master of 
 St. John's College, Oxford. He and Mr. Standley, his 
 companion, subsequently met them at dinner at my house 
 the same evening.
 
 150 SIXTY-FOUR YEARS A DOCTOR 
 
 SIR NORMAN MOORE. 
 
 I first met Sir Norman Moore, President of the Royal 
 College of Physicians, at the opening of the Cambridge 
 Research Hospital (where he delivered a very interesting 
 and instructive address), and the same evening we dined at 
 Sir Clifford Allbutt's house. Since then I have had the 
 pleasure of seeing him occasionally at the Royal College of 
 Physicians, and have had several interesting and instructive 
 letters from him. 
 
 In May, 1918, I wrote to ask his advice in reference to 
 the old editions of medical books as to whether it was desir- 
 able to keep them or destroy them. His reply was : — 
 
 A complete or even a numerous though not complete series of 
 the editions of any medical book is well worth preserving. I wrote 
 some 450 lives of British Physicians in the Dictionary of National 
 Biography, and such series were often most useful to me in tracing 
 the career of Physicians, the steps in whose professional life had long 
 been forgotten. The dates and locaUties given in their prefaces were 
 often the only record of where the physicians had lived. 
 
 Writing from Hancox, Battle, January 3rd, 1919, he 
 
 says : — 
 
 I have come here to my country house till Monday. All these 
 past years since 1914, we have heard the guns in Flanders, and now 
 it adds to the perfection of the country that all sounds of war are 
 ended. 
 
 In October, 1919, I sent to Sir Norman Moore a copy 
 of an address I had delivered to the Fylde Medical Society 
 on " Music and Medicine." 
 
 He shewed his intimate acquaintance with the subject 
 by several very interesting illustrations of it, and concluded 
 his letter by saying : — 
 
 I do not mention these additions as defects in your charming 
 essay, but only as shewing how much there is in your subject. 
 
 SIR F. W. MOTT, K.B.E. 
 Sir F. W. Mott, K.B.E., one of the greatest authorities 
 on War Neuroses and Shell Shock, and the extensive writer 
 on many other subjects, attracted me by his supplementary 
 obituary notice of the late Dr. Henry Maudsley. I after- 
 wards wrote to tell him how intimate I had been with Dr.
 
 SIXTY-FOUR YEARS A DOCTOR 151 
 
 Maudsley, that I had been his guest when he was at Cheadle, 
 and also at Brentwood, in Surrey, and had watched with 
 much interest his advancement to the high position which 
 he ultimately held. I forwarded to Sir F. W. Mott all the 
 letters which I had received from Dr. Maudsley, including 
 the memorable open post card on which he wrote : — 
 
 A man who has such a memory for detail as you appear to have 
 ought to be buried in his back garden. 
 
 I felt much sympathy with Dr. Maudsley in his annoy- 
 ance with the London County Council for their delay in 
 making use of the ^^30,000 which he gave to them for the 
 erection of a hospital for the treatment of incipient mental 
 disease. This building has been erected at Lavender Hill, 
 and it was not completed until after Dr. Maudsley's death, 
 so that he was deprived of the satisfaction of seeing his good 
 intention carried out. 
 
 Referring to an article in the British Medical Journal 
 
 on the philosophy of music. Sir Frederick Mott observes 
 
 (September 27th, 1919) :— 
 
 May I be allowed to say that two years ago I started singing 
 as a health restorative to the nervous system of soldiers convalescent 
 from war neuroses, and through the energy and interest taken by 
 the Countess Dowager of Carnarvon, " Vocal Therapy," for restoration 
 through speech and song and correct breathing, has received the 
 widest support, and has already accomplished much. 
 
 The Secretary's Office of the Vocal Therapy Fund, for 
 which Sir Frederick seeks support (1919), is situated at 
 32, Charles Street, Mayfair, W.7. 
 
 SIR BERKELEY MOYNIHAN. 
 I had often heard of the great reputation of Sir 
 Berkeley Mo^mihan, but I only made his personal acquaint- 
 ance in 1911, when I went to Leeds to see him operate on 
 one of my patients. The operation was one of which the 
 late Sir Thomas Watson said " there is no operation more 
 beneficent in its design, nor successful in its results, than 
 that which is undertaken for the removal of gall stones." 
 From the subsequent history of this patient's case, I can 
 confirm Sir Thomas Watson's remarks.
 
 152 SIXTY-FOUR YEARS A DOCTOR 
 
 I regarded it as a great pleasure and privilege to be 
 present at what was, in every sense, a very successful 
 operation, and under such circumstances to make the personal 
 acquaintance of Sir Berkeley Moynihan. 
 
 MADAME NORMAN NARUDA. 
 Madame Norman Naruda was one of the most important 
 instrumentalists who was engaged by the Musical Committee 
 of the Preston Guild of 1902. Her reputation as a violinist 
 was one of the highest to be obtained. My sister and I had 
 the honour of entertaining her and her sister during the 
 Guild Week. She made me feel that I was incurring some 
 responsibility when she told me that her violin was valued 
 at ;{5,000. It interested me to recall that at the Guild 
 of 1882 I sat next to her husband. Sir Charles Halle, at a 
 luncheon given by the Guild Mayor. 
 
 DR. OMEROD. 
 
 Dr. Omerod, the Registrar of the Royal College of 
 Physicians, did me the honour of calling upon me when 
 he came to Preston on behalf of the College to examine 
 the chemical and physical laboratories of the Preston 
 Grammar School, Moor Park Avenue, with a view to its 
 being recognised as a properly equipped teaching centre. 
 
 I was the more interested in his visit on account of 
 my association with his son. Captain Omerod, who was 
 Assistant Chief Constable of Lancashire until he was called 
 upon to rejoin his regiment during the war. 
 
 I was also the more interested in Dr. Omerod 
 because he was the successor to my dear old friend, 
 Dr. Edward Liveing, who had held the office for so many 
 years. 
 
 SIR WILLIAM OSLER. 
 
 I was introduced to Dr. William Osier, as he then was, 
 by my friend. Dr. Collinson, of Preston, at the annual 
 meeting of the British Medical Association at Belfast. 
 Shortly afterwards we met accidentally in London, at a 
 meeting of the Royal Society of Medicine in 1 Wimpole
 
 SIXTY-FOUR YEARS A DOCTOR 153 
 
 Street, W., when I was surprised that he recognised me, 
 and still more so when he invited me to spend a few days 
 with him at 13, Norham Gardens, Oxford. He arranged 
 a day and hour when I must meet him at the Royal College 
 of Physicians, and travel with him to Oxford by the Great 
 Western Railway in a dining car. I was much impressed 
 by the affectionate embrace which he received from his 
 wife on our arrival at Norham Gardens, and by the hearty 
 welcome which she gave to me. On hearing from his wife 
 that a niece who had come on a visit was ill. Sir W. Osier 
 said to me, " Brown, just run upstairs and see what is the 
 matter with her." I was a little afraid that I might not 
 be able to make a correct diagnosis, but my embarrassment 
 disappeared when I found that the young lady had 
 measles. 
 
 Sir W. Osier gave up a morning to show me several 
 of the colleges, and, with the aid of a guide to Oxford, I 
 inspected the exterior and grounds of others. On the 
 Friday afternoon he went with me to the service at 
 Magdalen College ; and at the conclusion of it to the choir 
 vestry, to see Dr. Varley Roberts, the organist, whom I had 
 once the pleasure of meeting at luncheon at the house of 
 a mutual friend, Mr. Standley, at Lytham, a pleasant little 
 seaside place, about 12 miles from Preston and nine from 
 Blackpool. 
 
 On the day following my arrival at Oxford, Sir William 
 gave a dinner to the members of the Book Club, of which 
 he was the President. He described his guests, of whom 
 there were 16, as University Readers, and some of the most 
 learned men in the world. One of them who sat on my 
 right was an eminent geologist, and I was the more 
 interested in him when he told me that he had been in 
 Preston to see one of His Majesty's Inspectors of Schools. 
 I felt a Httle embarrassed when Sir William gave me the 
 position of honour on his right, but the after reflection on 
 his dinner party and the kindness which I received from him 
 and his guests, made an impression on me which I shall 
 never forget. When I said " Good-night ! " to Lady Osier,
 
 154 SIXTY-FOUR YEARS A DOCTOR 
 
 after the dinner party, she said, " I have just been up to 
 your bedroom to see that there is a good fire in it." 
 
 A year or two after this pleasant experience, I met 
 Sir WilHam Osier again at one of the Royal Society of 
 Medicine meetings, and was invited to dine with him at 
 the Automobile Club. His other guests were a wealthy 
 American friend and Mr. Horace Barlow, the Assistant 
 Librarian of the Royal College of Physicians. Although 
 this visit was paid before the outbreak of war in 1914, he 
 showed me the preparation which had been made in the 
 provision of beds and other appliances for converting the 
 building or a portion of it into a hospital. 
 
 Shortly after my visit to Oxford I received the following 
 letter : — 
 
 Dear Dr. Brown, 
 
 I send you a reprint of your namesake's " Religio Medici," which 
 we have just issued from the Clarendon Press. If you and the author 
 have not common ancestors, at any rate you have common traits. 
 
 In September, 1914, I received a letter of which the 
 
 following is a copy : — 
 
 Kind man, — Please give me a subscription for the Louvain 
 Professors. We are arranging to look after them for the winter, and 
 it is a big job. Professor Deny's wife and five children came to us 
 to-day. Nothing saved — -house, library, and laboratory all gone. 
 He is the distinguished bacteriologist. Lady Osier sends greeting. 
 
 On September 14th, 1914, he wrote : — 
 
 Kind man for your bis-dat-gift, which I shall hand over quietly 
 to a young Belgian Professor, who has apparently only escaped with 
 his clothes, and wife and children, and one precious manuscript from 
 the Library, which he had in the house with him. 
 
 On July 7th, 1919, he wrote:— 
 
 So nice to have the chppings and to see that you have got your 
 coat off about Tuberculosis, and as Roosevelt would say, " are still 
 in the ring." 
 
 On January 4th, 1915 :— 
 
 It was so good of you to have done so much for poor Van Gehuch" 
 tein, in Cambridge, whose death is a sad loss. 
 
 SIR JAMES PAGET. 
 I was asked to give chloroform to a lady a few miles
 
 SIXTY-FOUR YEARS A DOCTOR 155 
 
 from Preston, when Sir James Paget had arranged with her 
 to remove a mammary tumour which was causing her 
 much anxiet5^ 
 
 We arrived at her house just as she was returning from 
 a drive in her victoria, and we had to wait until all the 
 necessary preparations had been made for the operation. 
 
 During this interval. Sir James told us that he really 
 thought this good lady would live longer if she did not 
 undergo an operation, but she had importuned him so much 
 to perform one, and that she looked with so much anxiety 
 on the continued presence of the tumour, that he had very 
 reluctantly consented to carry out her wishes. She was 
 a most unfavourable patient for either an anaesthetic or 
 surgical interference, on account of her stoutness, and my 
 mind was much relieved when she recovered from the 
 immediate effects of the chloroform. She went on favourably 
 for a few days, and then died from septic pneumonia at the 
 end of a fortnight. I am afraid that all the up-to-date 
 precautions were not carried out, although I did not see 
 the lady again after the day on which I administered the 
 anaesthetic. 
 
 SIR RICHARD DOUGLAS POWELL. 
 Shortly after I had received the intimation that I had 
 been elected a Fellow of the Royal College of Physicians, 
 Sir Richard Douglas Powell wrote a letter to me stating 
 that as he was the President of the College, it would be 
 his official duty to induct me. He also invited me to be 
 his guest at the dinner in the evening, at which the President, 
 some members of the Council, and other Fellows were also 
 present. 
 
 Between the conclusion of the ceremony in the afternoon 
 and the dinner in the evening. Sir Douglas Powell took me 
 in his motor car to his house, 62, Wimpole Street, Cavendish 
 Square, and showed me his library and other objects of 
 interest. He also drove me back to the College. As I was 
 then 72, I regarded this kind attention as a tribute of respect 
 for my age, and appreciated it very much indeed. I had 
 previously corresponded with Sir Douglas Powell, and had
 
 156 SIXTY-FOUR YEARS A DOCTOR 
 
 availed myself of his valuable advice and guidance, but 
 I had never before had the pleasure of seeing him. 
 
 DR. KENDRICK PYNE. 
 I had often heard of the great reputation of Dr. Pyne 
 as the Organist of the Manchester Cathedral and the Pro- 
 fessor of Music at the University of Manchester, but I never 
 had the pleasure of making his acquaintance until one day, 
 during the summer months, I met him on the road between 
 Cleveleys and Blackpool. He was taking a walk with my 
 nephew, Frederick Gregson Shuttleworth, the Organist of 
 St. Mary Abbots, Kensington, and he introduced us. He 
 was my guest on two occasions from Saturday to Monday, 
 and both I and the friends whom I invited to meet him 
 highly appreciated his company and his conversations. 
 On one of the Sundays he kindly consented to read the 
 lessons at the Church which I attended, and the members 
 of the congregation were much impressed by the contrast 
 between his elocution and that of an ordinary clergyman. 
 He made the slight mistake of reading the whole of one 
 of the chapters assigned for the lesson, when he ought only 
 to have read a portion of it, but this was regarded as a 
 pleasurable rather than a culpable error. Dr. Pyne was 
 quite at home in the various rooms in my house which 
 contained books, and his happiness appeared to be much 
 increased by the frequent indulgence in a good cigar. 
 
 MR. SIMS REEVES. 
 Mr. Sims Reeves, whose lovely tenor voice always 
 afforded very great pleasure to all sorts and conditions of 
 men who possessed an ear for music, was one of the principal 
 vocalists at the Preston Guild of 1862. During the Guild 
 Week he resided at Farington Vicarage, about three miles 
 from Preston. One day I was sent for to visit him at the 
 Park Hotel, Preston, for the purpose of giving a certificate 
 stating that, in consequence of a slight cold, he was unfit 
 to sing at one of the East Lancashire towns the following 
 evening. He told me that he had made up his mind never
 
 SIXTY-FOUR YEARS A DOCTOR 157 
 
 to sing in public unless he was in good voice, and that by 
 doing so he had lost many thousands of pounds and been 
 the subject of very unpleasant imputations. I was very 
 much interested in my conversation with him, especially 
 when he told me that he had been the organist at a church 
 when he was only 12 years of age, and that when he travelled 
 he always took his own sheets lest he should be placed in 
 a damp bed. 
 
 SIR B. W. RICHARDSON. 
 A few years ago, three members of the Preston 
 Temperance Society came to my house to ask if I would 
 oblige them by taking the chair at a lecture on the " World 
 Without Wine," which they had arranged to be delivered 
 by Dr. B. W. Richardson, the inventor of the " lethal 
 chamber " for the painless destruction of dogs and other 
 animals ; the author of " Hygeia, a City of Health," and 
 many other articles. I told them that I was a most un- 
 suitable person to be their chairman, as I regarded myself 
 as a moderate drinker and had been condemned by Mr. 
 Joseph Livesey, one of the six Preston pioneers of the great 
 teetotal movement. Mr. Livesey is reported to have said 
 that he had more hope of a drunkard than he had of a 
 moderate drinker, and I may say that I am almost a total 
 abstainer. After I had made the above introductory 
 remarks, I told the deputation that I should be glad if 
 Dr. Richardson would make my house his home during his 
 visit to Preston, and that it would be a pleasure to me to 
 preside at the meeting. I invited some of the Preston 
 medical men to have a cup of tea before going to the lecture, 
 and a few others to have supper with him after. As I was 
 on the point of leaving the house, a telegram was handed 
 to me, sent by a medical man at Blackpool whom I had 
 not invited, and whom I knew was anything but a 
 sympathiser with the temperance movement. Someone had 
 told him about the proposed lecture, and my intended 
 entertainment, and his telegram ran thus, " Sorry that the 
 Mayor and I cannot arrive in time for the tea, but please 
 leave the brandy on the sideboard."
 
 158 SIXTY-FOUR YEARS A DOCTOR 
 
 LORD ROBERTS. 
 
 Some time after I had retired from the 3rd Royal 
 Lancashire Militia, I joined a society called the Red Rose 
 Club. Past and present officers of the Militia were invited 
 to become members of it, and I was one of the earliest to 
 join. A dinner was held annually in different towns and 
 cities, amongst them were Preston, Liverpool, Manchester, 
 London, and other places. 
 
 I had the pleasure of being present at a dinner which 
 was given by the Society at the Savoy Hotel to Lord 
 Roberts. All those who had accepted the invitation 
 received an intimation that the cook (who was said to have 
 ;r5,000 a year) was particularly anxious that the dinner 
 should commence punctually at the minute fixed for it to 
 do so, that justice might be done to him and his very care- 
 fully prepared menu, and an endeavour was made to observe 
 the injunction. Lord Roberts, however, arrived half an hour 
 late, for which he made an ample apology, and explained 
 that he was under the impression that the dinner was to take 
 place at the Hotel Cecil. On enquiring there, however, he 
 was told that they knew nothing whatever about it. He 
 was therefore obliged to go to the West End to read his 
 invitation card in order to obtain the correct address. 
 
 The allusion to the Savoy cook and his £5,000 a year 
 recalls to my mind the experience of a gentleman who was 
 in the habit of inviting a few friends to dine with him at 
 some hotel which had a reputation for the excellence of 
 its catering. In the early part of his experience, he was 
 so much pleased with one of the dinners that he said he 
 would like to see the cook. He expected to see a stout, 
 red-faced lady, and he took out of his pocket a guinea to 
 present to her. To his surprise the cook came up, but he 
 was a gentleman in evening dress. The host was at first 
 a little embarrassed, but he put his hand in his pocket, 
 took out a larger amount, and asked the gentleman in 
 evening dress to distribute his gift amongst the persons 
 who had taken part in the preparation of the excellent 
 dinner.
 
 SIXTY-FOUR YEARS A DOCTOR 159 
 
 FREDERICK GREGSON SHUTTLEWORTH. 
 
 Frederick Gregson Shuttleworth, organist of St. Mary 
 Abbot's, Kensington, is my nephew. He succeeded the late 
 Mr. Henry Bird, with whom he had been assistant for 
 25 years. 
 
 He is the son of Thomas Moss Shuttleworth, late Clerk of 
 Assize of the Northern Circuit. His grandfather, Thomas 
 Starkie Shuttleworth, previously held the same appointment 
 for many years. 
 
 His brother Arthur is an Associate of the Northern 
 Circuit. 
 
 During the war. Dr. Stanley Marchant, the sub-organist 
 of St. Paul's Cathedral, was in the Army. His place in the 
 Cathedral was taken by Mr. Reginald Yarrow, organist of 
 St. Jude's, South Kensington, and a former chorister at 
 St. Paul's. Mr. Yarrow was later on " called up," and 
 Mr. Shuttleworth took his place, sharing the duties of 
 sub-organist with Mr. Glanville Hopkins, a nephew of the 
 late Dr. E. J. Hopkins. Mr. Shuttleworth was also put 
 on the staff of pianoforte teachers in the choir school, and 
 still holds the position of a music master there, occasionally 
 taking the boys' rehearsal for the daily services, and 
 frequently playing the organ in the Cathedral at the 
 morning and afternoon services. 
 
 MR. ALBERT SIMPSON. 
 
 When I was a Certifying Surgeon under the Factory 
 Act, I frequently met Mr. Albert Simpson at one or other 
 of his factories, where he was largely engaged in business 
 as a cotton spinner and manufacturer. 
 
 After receiving many kind invitations to visit him at 
 Burghill Grange, Hereford, I went there, and enjoyed my 
 visit exceedingly. Mrs. Simpson met me at Hereford 
 Station, and gave me a pleasant three miles drive in her 
 pony car. 
 
 BurghUl Grange is a model country house as regards 
 size, surroundings, situation, and internal arrangements. 
 
 There is much evidence in the village of Mr. Simpson's
 
 160 SIXTY-FOUR YEARS A DOCTOR 
 
 kindness and forethought in providing a Club House and 
 Library for his neighbours, and an organ for the Church, 
 and in many other ways he has endeavoured to promote 
 their welfare and happiness. 
 
 Mr. Simpson is such an eminent authority on invest- 
 ments that he communicated a great deal of valuable 
 information to me on that subject, and made me more 
 comfortable in reference to some in which I had great interest. 
 
 I cannot speak too highly of the kindness and hospitality 
 of Mr. and Mrs. Simpson, which made such an impression 
 upon me that I gratefully accepted from them another 
 invitation, and paid a second visit to them in 1913, on my 
 way to Osborne. 
 
 Mr. Simpson was High Sheriff for Radnorshire, 1907 
 and 1917. In 1907 he was appointed a County Magistrate 
 for Lancashire, and since then for three other counties. 
 
 SIR JAMES YOUNG SIMPSON. 
 The name of Sir James Young Simpson recalls to my 
 mind the great kindness which I received from him in the 
 early part of 1862, and for which I became indebted to him 
 through circumstances connected with what was known as 
 the " Cotton Famine." This famine was due to the great 
 war between the Northern and Southern States of America, 
 and it lasted from 1861 to 1865. The cotton trade of 
 Lancashire was paralysed by it, and there was great poverty 
 amongst the operatives. Preston was one of the most 
 distressed of the Lancashire towns, and when a knowledge 
 of this reached Sir James Simpson he sent his nephew, 
 Dr. Alexander Russell Simpson (now Sir A. R. Simpson) 
 and his own son David to investigate some of the most 
 distressed cases and distribute relief amongst them. I was 
 at that time resident Medical Officer of the Preston 
 Dispensary, and as my duties brought me into contact with 
 some of the worst cases of distress, Sir A. R. Simpson and his 
 cousin were recommended to make my acquaintance. In con- 
 sequenceof the attention which I had shown to them, I received 
 a very kind invitation from Sir James to visit Edinburgh for a
 
 SIXTY-FOUR YEARS A DOCTOR 161 
 
 few weeks, and to attend at his house, 52 Queen Street, every 
 evening to see the work carried on by his two assistants, 
 Dr. A. R. Simpson and Dr. J. Watt Black, who subsequently 
 removed to London and became attached to Charing Cross 
 Hospital. I went to Edinburgh on March 10th, 1863, the 
 wedding day of the late King Edward the Seventh, and 
 remained there about six weeks. The patients who came 
 to 52, Queen Street, to see Drs. A. R. Simpson and Black 
 were chiefly well-dressed females, who never seemed to pay 
 any fee, but on leaving the house were presented with a 
 religious tract along with the prescription. In addition to 
 having a knife and fork always at my disposal, I was 
 invited to dinner on certain special occasions, and 
 I remember that, on one of these, I met Dr. Alexander 
 Wood, The President of the Royal College of Physicians 
 of Edinburgh ; Dr. Andrew Wood, the President of the 
 Roj^al College of Surgeons ; and Dr. Littlejohn, the Professor 
 of Forensic Medicine. Their conversation was, of course, 
 very entertaining, and it was rendered all the more so by 
 the constant discharge of volleys of puns, for the utterance 
 of which each of them seemed to have a special faculty. 
 When I left Edinburgh I went for a few weeks to the 
 Rotunda Hospital, Dublin, and I again experienced the 
 advantage of having made Sir James Simpson's acquaintance 
 in receiving from him letters of introduction to Sir William 
 Wilde (father of the late Oscar Wilde), Sir William Stokes, 
 Professor Philip Crampton Smyly, an eminent surgeon, and 
 Dr. Denham, the Master of the Rotunda Hospital. 
 
 MR. HENRY SMART. 
 I was at Christ Church, Preston, in August, 1865, when 
 Mr. Henry Smart opened the new organ, and was delighted 
 to have the opportunity of hearing a musician who possessed 
 such a wonderful faculty for producing harmonious sounds. 
 On Advent Sunday, 1876, when I was staying at the Euston 
 Hotel, London, I went across the Euston Road to 
 St. Pancras' Church, where Mr. Henry Smart accompanied 
 the service on one of Henry Willis's fine organs. I was
 
 162 SIXTY- FOUR YEARS A DOCTOR 
 
 very much impressed with his treatment of a hymn tune 
 which was an adaptation of " Sleepers, Awake !" from 
 Mendelssohn's oratorio, "St. Paul." I was subsequently 
 very much interested in the obituary notice of Mr. Henry 
 Smart which appeared in the " Tonic Sol-fa Gazette." 
 I ought to mention that the choir at St. Pancras Church 
 at that time consisted only of the members of the 
 congregation, school children, and young men from a 
 neighbouring Training College, and that the singing was 
 entirely in unison. As Mr. Smart was afflicted with blind- 
 ness, he had a boy standing by him in the organ loft to tell 
 him the subject of each succeeding verse, in order to adapt 
 the harmony of which he had such a master knowledge to 
 the words. 
 
 MR. F. W. SMITH. 
 
 I first met Mr. and Mrs. F. W. Smith at the wedding 
 of their son, F. J. Smith, to Susan, daughter of my dear 
 friend the late Dr. Dunn, of 25, Winckley Square, Preston. 
 From that day to this it has appeared to be the wish of 
 Mr. Smith to show me as much kindness and attention as 
 possible. 
 
 Mr. and Mrs. Smith have frequently entertained me 
 at their beautiful house, Woodville, Longridge, where the 
 lovely gardens and conservatories are well known to be 
 as fine as any in the County of Lancaster. Mr. Smith 
 possesses a wonderful knowledge of flowering plants, and 
 his views on horticulture (which he seems to have great 
 pleasure in imparting to others) constitute him a very 
 high authority on such matters. 
 
 For several years in succession he has invited me to 
 stay with him and his family at the Low Wood Hotel, 
 Windermere, and each morning his great anxiety seems to 
 have been to make my day's enjoyment as great as possible. 
 He has endeavoured to show me some of the most beautiful 
 scenery in the Lake District, and I must especially mention 
 a garden near the Low Wood Hotel, which contains a 
 collection of shrubs probably vmsurpassed, if equalled, in 
 any garden in England.
 
 SIXTY-FOUR YEARS A DOCTOR 163 
 
 THE REV. GEORGE SMITH 
 
 (Chaplain to the Forces.) 
 
 The Rev. George Smith lived at Sumner's Hotel, 
 Fulwood, from April, 1898, to November 27th, 1918, and 
 passed away there. 
 
 I frequently entertained him at 27, Winckley Square, 
 and also met him at the houses of some of my friends. 
 
 On account of the active part which he took in the 
 defence of Rorke's Drift during the Zulu War in 1879, in 
 combination with Lieutenant Chard, R.E., and Lieutenant 
 Bromhead, 24th Regiment, it was thought by many people 
 that he ought to have been awarded the Victoria Cross. 
 
 During a portion of the time my nephew, the late 
 Major George Lamont Hobbs, the Connaught Rangers, was 
 at Malta, the Rev. George Smith was also there. In after 
 years, when they met again in my house, it was interesting 
 to hear them comparing notes of what they heard and saw 
 when they were in Malta. 
 
 DR. T. P. S. STRANGEWAYS 
 (Huddersfield Lecturer on Pathology.) 
 
 Dr. Strangeways called upon me one day in 1904, to 
 tell me that he was engaged in endeavouring to establish 
 a Hospital at Cambridge, for the purpose of studying one 
 disease only at a time, and that it had been decided to 
 commence with what is known as " rheumatoid arthritis." 
 He wished me to call a meeting of the Preston medical men 
 to make known to them the object of his visit to me, and 
 to enlist their sympathy and help in promoting the success 
 of his work. I also assisted him by writing to some medical 
 friends in Lancaster, to which place he went the next day 
 and had a very kind and encouraging reception. 
 
 In 1912 I had the honour of opening the new Research 
 Hospital at Cambridge, and since then the study of 
 rheumatoid arthritis has been carried on not only in the 
 hospital, but in all parts of England, Scotland and Wales. 
 An arrangement has been made by which intimation has 
 been sent from the house in which the rheumatic patient
 
 164 SIXTY- FOUR YEARS A DOCTOR 
 
 is living, and Professor Strangeways or one of his colleagues 
 has visited and examined the patient and taken accurate 
 notes of his condition and history. 
 
 A pathological museum has been formed, to which new 
 specimens are added as occasion offers. This collection has 
 been made in order that Dr. Strangeways and his assistants 
 may be in a position to demonstrate the various changes 
 which occur in the joints in rheumatoid arthritis and 
 other similar diseases. 
 
 MR. OWEN THOMAS AND HIS ATTIRE. 
 Mr. Thomas, the inventor of the sphnt which bears 
 his name and has been the means of giving comfort to, 
 and promoting the health of, many invalids in aU parts 
 of the world, came over to a village near Preston to see 
 a patient with me in consultation. The man was suffering 
 from caries of the bones of the right foot, following a 
 fractured leg, and pus was flowing freely from several 
 sinuses. Mr. Thomas arrived in a station cab carrying a 
 zinc pail or bucket containing his antiseptic sawdust and 
 two or three netted articles which looked like dishcloths. 
 He wore a little cloth cap with a bright button on each side 
 for the attachment of a strap to be fastened under his chin 
 to prevent his cap from being blown off on a windy day. 
 His coat sleeves were rather short, and he did not wear 
 gloves. Another medical man and I thought that the case 
 was one in which amputation was the only remedy, but 
 Mr. Thomas thought otherwise, and was confident that he 
 could save the foot. He covered it freely with his anti- 
 septic sawdust, and retained this in position with his 
 dishcloth-like article. He instructed me to change the 
 sawdust every day, cleaning the foot as weU as I could 
 with a piece of stick, but never to wash it. The suppuration 
 gradually ceased and the sinuses healed, but the foot 
 assumed the shape of a dumpUng, was of no use, and had 
 to be amputated. Mr. Thomas wrote the prescription for 
 the antiseptic sawdust for me on the bottom of a match 
 box, and the composition of it was as follows : —
 
 SIXTY-FOUR YEARS A DOCTOR 165 
 
 To four bucketfuls of sieved pitchpine sawdust, not 
 sieved too fine, add, in solution, a mixture of chloride of 
 lime ^Ib., crude carbolic acid 4oz., liq. hydragyri perchloridi 
 4oz. The chloride of lime, carbolic acid and liq. hydragyri 
 perchloridi should be mixed with about two bucketfuls of 
 water. 
 
 He very kindly invited me to visit him at 11, Nelson 
 Street, Liverpool, where I was much interested in seeing 
 some of his assistants, which comprised a joiner, a black- 
 smith, and a saddler. I also saw his carriage, which was 
 a well-known object of interest in Liverpool. It resembled 
 one of the old-fashioned fire engines, and he rode sideways 
 in it. 
 
 TOM THUMB. 
 
 I have seen many interesting sights in Fishergate, but 
 none more so than the miniature carriage, the Liliputian 
 horses, and the diminutive coachman and footman of 
 General Tom Thumb. Seated within the carriage, the 
 General was a conspicuous object. He gave "At Homes" 
 at the Bull Hotel, which I and my brothers and sisters had 
 the privilege and pleasure of attending. 
 
 Charles Heywood Stratton (termed General Tom 
 Thumb), an American, was exhibited in England by Mr. 
 P. T. Barnum, in 1846. In February, 1863, in New York, 
 when 25 years old, and 31 inches high, he married Lavinia 
 Warren, aged 21, 32 inches high. 
 
 General Tom Thumb, his wife and child, and Com- 
 modore Nutt, another dwarf, came to England in December, 
 1864, and remained here some time. During the second 
 visit to Preston they gave " At Homes." During this visit 
 Commodore Nutt had the misfortune to fracture his kneecap, 
 and I had the honour of paying him a professional visit 
 at the Bull Hotel. 
 
 There was a rumour very prevalent that Tom Thumb 
 was addicted to drink, in reference to which our old friend 
 " Punch " remarked that it would be some consolation to 
 his wife that he would not hold much. 
 
 Tom Thumb died 15th July, 1883.
 
 166 SIXTY-FOUR YEARS A DOCTOR 
 
 SIR ALFRED TOBIN. 
 I made the acquaintance of Sir Alfred Tobin when 
 he called to remind me that he was a candidate for the 
 honour of representing Preston in Parliament. 
 
 He was one of my guests at a dinner which I gave to 
 some of the most important members of the Lancashire 
 and Cheshire Branch of the British Medical Association, 
 when the annual meeting was held in Preston in 1913. 
 
 The last time I met him was at the Euston Hotel, in 
 London, when he was on his way to a ball at the Earl of 
 Derby's in St. James's Square. 
 
 On December 3rd, 1921, I received the following letter 
 
 from him : — 
 
 Dear Sir Charles, 
 
 I was so delighted to read your cheery, bright reminiscent letter 
 in the Preston Herald. It was hke a whiff of salt sea air, reminding 
 me of happy, healthy times in dear old Preston. 
 
 I always recall your constant kindness to me. I never forget 
 the Freeman of Preston. With all good wishes. 
 
 Your afiectionate friend, 
 
 ALFRED TOBIN. 
 
 SIR FREDERICK TREVES. 
 
 When I heard that Sir Frederick Treves had consented 
 
 to favour the Corporation of Preston by accepting their 
 
 invitation to open the new Isolation Hospital in Deepdale 
 
 Road, I wrote and invited him to dine with me, and to 
 
 remain at my house all night. His reply was : — 
 
 I am much obliged to you for your kind letter. I am sorry that 
 I am compelled to make my visit to Preston so short, but in the early 
 part of June I am very much occupied in London, and if I make 
 arrangements to be away longer I may have to abandon them. I 
 find that I can come by a train which leaves Euston at 11-30 a.m., 
 and reaches Preston at 3-35 p.m. It is a restaurant train, so I will 
 come by that. 
 
 Sir Frederick Treves is evidently a believer in the 
 
 maxim, " Early to bed and early to rise, makes a man 
 
 healthy, wealthy and wise." In one of his letters he says : — 
 
 I am glad you beheve in early rising. I am writing this at 6 a.m., 
 and it is a fine, clear morning. 
 
 We are told in an article which appeared in a recent number 
 of Chambers's Journal on " Doctors, Old and New," that
 
 SIXTY-FOUR YEARS A DOCTOR 167 
 
 Sir Frederick Treves rises every morning at five o'clock 
 and breakfasts at seven o'clock. 
 
 It would be impossible to discover anyone who 
 occupied a more responsible position than Sir Frederick 
 Treves did when he was called upon to conduct the surgical 
 measures which were necessary to save the life of King 
 Edward the Seventh. During the anxiety associated with 
 the King's illness, it was a consolation to every member 
 of the medical profession that the surgical treatment of the 
 King was under the control of such an eminent authority 
 on the disease from which the King was suffering ; 
 medical men throughout the country were thus enabled to 
 give confidence and hope to the general public. 
 
 When Sir F. Treves retired from private practice, it 
 seems to have been a starting point for a display of renewed, 
 if not increased energy. He commenced by making a tour 
 round the world, during which he visited India, Burma, 
 and Ceylon, China, Japan, and America, and his graphic 
 description of what he saw and heard during his travels 
 has been so attractive to the public that no less than five 
 editions of his book, " On the Other Side of the Lantern," 
 have been issued during a very short space of time. He 
 displayed his patriotism by volunteering at the beginning 
 of the Boer War to go to South Africa. He abandoned for 
 a time his lucrative practice, and was appointed consulting 
 surgeon with the Field Force. He served with Buller's Army 
 in Natal, was present at the Battle of Colenso and through 
 the prolonged operations which resulted in the relief of 
 Lady smith. 
 
 Sir Frederick Treves has been a great sanitary reformer, 
 and has not only pointed out the physical effects of alcohol, 
 but also what might not have been expected, the danger 
 of tea shops. He is still an enthusiastic sanitary reformer, 
 and has given great assistance in effecting an improvement 
 in the Royal Army Medical Corps. Sir Frederick Treves 
 has also given us some very interesting information about 
 the County of Dorset, in the chief town of which, Dorchester, 
 he was born.
 
 168 SIXTY-FOUR YEARS A DOCTOR 
 
 The Isolation Hospital. 
 
 It was high time for Preston to have a properly 
 equipped Isolation Hospital. A few years before this one 
 was provided. As I was Medical Officer to the London and 
 North-Western Railway Company, I was sent for by the 
 stationmaster to see a man who was walking about the 
 platform with an eruption on his face. I found that he 
 was suffering from smallpox, which seemed to terrify the 
 people on the platform. He had come on the train 
 from Fleetwood, and when I asked him if he had seen 
 his face in the looking-glass, he told me that he had slept 
 all night in a shed where there was no looking-glass. I asked 
 the stationmaster to let me have a porter to prevent the 
 man from going into any of the waiting-rooms or leaving 
 the station. I walked with the porter and the man to the 
 house of the Medical Officer of Health, who lived in 
 Winckley Square, a few yards from my own house. When 
 he came to his front door I asked him if he would kindly 
 give me an order for the admission of the man into the 
 Ducker Hospital. The Ducker Hospital was a temporary 
 building provided by the Corporation for the admission and 
 treatment of cases of smallpox. The Medical Officer of 
 Health shrugged his shoulders and said it was no use giving 
 him an order for the Ducker Hospital, as it contained no 
 matron, nurse, or other arrangement for the admission and 
 treatment of smallpox cases. As I wished to protect the 
 poor man from any further exposure and the public from 
 danger, I walked with him and the porter to a building 
 adjoining the Office of the Medical Officer of Health in 
 Tithebarn Street. This place was used for the disinfection 
 of clothing, and was warm and smelt strongly of sulphur. 
 I next telephoned to the Master of Fulwood Workhouse, 
 and asked if he would kindly admit a case of smallpox. 
 He replied that it would be more than his place was worth 
 if he were to do so, as the Guardians had given strict orders 
 that he must not admit a case of smallpox under any 
 circumstances whatever. 
 
 I next went to the Borough Police Office and explained
 
 SIXTY-FOUR YEARS A DOCTOR 169 
 
 to the Inspector on duty the position in which I was placed. 
 He very kindly sent a sergeant to the house of the Relieving 
 Officer of the District. He repeated the objections which 
 the Master of the Workhouse had expressed, but ultimately, 
 under strong protest, gave the necessary order, and removed 
 the man in the cab provided for infectious diseases to the 
 Workhouse. 
 
 At the earliest possible opportunity the train in which 
 the man had travelled from Fleetwood was shunted into a 
 siding and all the carriages comprising it were disinfected. 
 
 The Isolation Hospital was the result of the indefatigable 
 efforts of the late Alderman and ex-Mayor, Daniel Walter 
 Brown, in spite of strenuous and discouraging opposition. 
 
 During his stay in Preston, Sir Frederick Treves visited 
 the operating theatre of the Preston Royal Infirmary, and 
 expressed his great admiration for it, and for all the arrange- 
 ments connected with it. 
 
 COLONEL CHARLES J. TRIMBLE. 
 
 There is not a medical man in Preston or the neighbour- 
 hood with whom I have been longer or more pleasantly 
 associated than with Colonel Charles Trimble. 
 
 I made his acquaintance when he first came to Bamber 
 Bridge, and our friendsliip has never been interrupted by a 
 single disturbing incident. 
 
 I have admired his connection with the ambulance 
 movement, not only on account of the energy which he 
 has displayed in promoting the spread of ambulance know- 
 ledge, but also for the length of time with which he has 
 been engaged in it. He first took up ambulance work in 
 1883, when he instructed a class in this subject at Bamber 
 Bridge, and up to the present time he still displays the 
 greatest interest in it. 
 
 The organization known as the St. John Ambulance 
 Brigade was formed in 1895, and Colonel Trimble was 
 appointed Deputy Commandant to the No. 4 North- Western 
 District. I have also admired, more than I can express, 
 his patriotism in remaining so long an officer in the Territorial
 
 170 SIXTY-FOUR YEARS A DOCTOR 
 
 Force. He joined the Preston Artillery Volunteers in July, 
 1878, and was connected with this unit until December, 
 1913, having had the command of it for nine years. 
 In December, 1913, he joined the Territorial Reserve for 
 Officers, and was mobilised for active service in the Great 
 War on the 5th August, 1914. He was demobilised March, 
 1919. During the period of his service with the Volunteers, 
 this Force was altered and reorganised as the Territorial 
 Force. When I reflect on his services to his country during 
 the recent war, I am lost in admiration of him. 
 
 In October, 1914, the Order of St. John decided to 
 offer a Hospital containing 520 beds to the Government. 
 This was done, and the authorities accepted the proposal. 
 Etaples was chosen as the site of the institution. The 
 building of the Hospital began in April, 1915, and to this 
 locality some of the staff came on July 22nd, 1915. 
 
 The first convoy was taken in on September 8th, 1915, 
 and after that the wheels of the unit never ceased to turn 
 round — sometimes fairly quietly, and at other times with 
 great rapidity and a whirl, indicating much work and strain 
 — but with the magnificent staff, good equipment, and 
 unity of purpose, no pressure ever affected the scientific 
 or other efficiency of the work. 
 
 Those outside (well qualified to pass an opinion) 
 expressed in no uncertain words their admiration and 
 approval of the splendid work the Hospital was doing. 
 
 Colonel Trimble was in command for 2f years. 
 Previously he had charge of the medical side of the 
 Hospital for 12 months, and afterwards succeeded to the 
 command. 
 
 It is only just to say that the St. John Ambulance 
 Brigade Hospital was looked upon as one of the best, if 
 not actually the best, hospital of its type in France. 
 
 When in May, 1918, the Huns bombed the hospital 
 literally to pieces, killing and wounding several of the 
 patients and personnel, it was then his privilege to notice 
 that steadiness, bravery, and determination of the whole 
 staff. This was a most trying time, and when on May 31st,
 
 SIXTY-FOUR YEARS A DOCTOR 171 
 
 1918, the institution was devastated by enemy aircraft, 
 then the opportunity was given of judging the grit and 
 disregard for personal safety exhibited on all sides. The 
 first care was in the interests of the helpless patients, and 
 right nobly this duty was performed. In recognition of the 
 excellent services rendered by the Hospital, 11 different 
 classes of honours have been conferred by the King and the 
 Order of St. John of Jerusalem. So badly was the Hospital 
 knocked about by enemy aircraft that it could no longer 
 be used, and in July, 1918, it was moved to Trouville, where 
 it was rebuilt and reopened. About 1,000 patients have 
 been admitted since Armistice Day came. During the four 
 years it was in France, 48,000 sick and wounded passed 
 through it. 
 
 QUEEN VICTORIA AT FLEETWOOD AND PRESTON. 
 
 I was present at Fleetwood on the 21st September, 
 1847, when Her Majesty Queen Victoria, Prince Albert, 
 and the Royal children landed at Fleetwood in the 
 Victoria and Albert en route from Scotland to London. 
 Great rejoicings took place. 
 
 In October, 1852, the Queen determined to stay at 
 Preston on her route from Balmoral to London. Extensive 
 preparations were made to accord to Her Majesty a suitable 
 reception. The station was decorated with flags, mottoes, 
 etc. The first-class refreshment room, which was set apart 
 for the Royal party, was elegantly decorated, several 
 gentlemen from the town and neighbourhood contributing 
 from their works of art for this purpose. Other rooms were 
 likewise prepared for the Queen's suite and servants. The 
 principal of the ladies and gentry, as weU as a large concourse 
 of the inhabitants of the town and neighbourhood, attended 
 to do honour to Her Majesty and her family. The Mayor 
 presented, on behalf of the Municipal authorities, a suitable 
 address, and the Bishop of Manchester performed a similar 
 office for the clergy. Her Majesty's reception was of the 
 heartiest character, and afforded evident gratification to the 
 Royal party, although some people were so rude in crowding
 
 172 SIXTY-FOUR YEARS A DOCTOR 
 
 round the carriage, raising themselves on to the step, and 
 peeping in, that Queen Victoria is said to have determined 
 never to stop at Preston again. 
 
 Before the Preston Railway Station was rebuilt in 1882, 
 there was no bookstall under the management of W. H. 
 Smith & Son, but merely a large table at one end of the 
 platform containing newspapers and a few periodicals. 
 The saleswoman was a Miss Emily Lambert, who, on account 
 of her walking along the side of the trains calling out " The 
 Times," " Punch," was known to the regular passengers as 
 " Miss Punch." She was a great favourite, and had a smile 
 for everyone except for those who, in ignorance that the 
 price of " The Times " was sixpence, offered her only two 
 pence. 
 
 On a memorable occasion, however, she was seen to 
 shed tears, and this was when, in 1852, Queen Victoria left 
 the train for a short time at Preston Station. Miss Punch 
 had in her hand a copy of " The Times," and a beautiful 
 bouquet which she was about to present to the Queen, 
 when she was rudely pushed aside by one of the Lancashire 
 and Yorkshire Railway Directors. Much sympathy was felt 
 for Miss Punch when she was seen to be weeping, and great 
 indignation was expressed in reference to the officious 
 director. 
 
 MEMBERS OF THE ROYAL FAMILY WHOM I HAVE 
 SEEN IN PRESTON. 
 
 Queen Victoria in 1852. 
 
 Albert Edward Prince of Wales in 1885, when he came 
 to lay the foundation stone of the Dock. 
 
 Albert Edward Prince of Wales in 1885, when he came 
 to see the All-England Agricultural Show in Moor Park. 
 
 The Duke of Cambridge in 1867, when he came to open 
 the new Town Hall. 
 
 The Duke of Cambridge in 1882, when he came, during 
 the Guild Week, as the representative of the Duke and 
 Duchess of Albany, who were unable to come in consequence 
 of the illness of the Duke.
 
 SIXTY-FOUR YEARS A DOCTOR 173 
 
 The Duke of Edinburgh in 1892, when he came to open 
 the Dock. 
 
 King George and Queen Mary in 1913, when I and a few 
 other Prestonians were presented to them at the Guild Hall. 
 
 H.R.H. the Duke of York, May 20th, 1920, when he 
 came as the representative of the King to the investiture 
 of several Prestonians and others who had earned distinctions 
 in connection with the late war. My brother Freeman, 
 Mr. Forshaw, and I had the pleasure of sitting opposite 
 the Duke of York at the luncheon given by the Mayor at 
 the GuUd Hall. 
 
 The Prince of Wales in 1921, when I and other 
 Prestonians were presented to him. 
 
 MEMBERS OF THE ROYAL FAMILY WHOM I HAVE 
 SEEN ELSEWHERE. 
 
 Queen Victoria at the laying of the foundation stone 
 of the Medical Examination Hall on the Victoria Embank- 
 ment, London, 24th March, 1886. I had a very good view 
 of both the Queen and Sir Wm. Jenner, and had the pleasure 
 of hearing the fine band of the Scots Guards during the 
 proceedings. 
 
 In 1887, at the Jubilee, I had a good view of Queen 
 Victoria from the Royal College of Physicians in Cockspur 
 Street, which, with PaU Mall, was included in the route 
 through which the procession passed on its way to West- 
 minster Abbey. 
 
 On June 21st, 1897, I saw Queen Victoria at the 
 Diamond Jubilee, on her way to Westminster Abbey as the 
 procession passed the Royal College of Physicians in Cock- 
 spur Street ; Field Marshal the Right Honourable Lord 
 Roberts, riding a white horse, was at the head of the 
 procession, commanding the Colonial troops. 
 
 On May 21st, 1912, I was present when King George 
 and Queen Mary opened the Royal Society of Medicine 
 buildings in Henrietta Street, Cavendish Square. By 
 arriving there early, I secured such a good place I could easily 
 have touched Her Majesty's dress.
 
 174 SIXTY-FOUR YEARS A DOCTOR 
 
 COLONEL DOUGLAS WARDROP. 
 
 I met Lieut. -Colonel War drop accidentally in London 
 in 1912. I had not seen him for many years, and at first 
 had a difficulty in recalling his name. He told me that 
 he was Commandant of the Royal Army Medical College 
 at Millbank, which included the Military Hospital to which 
 some of the patients from Netley had been removed and 
 at which a secondary course of instruction was given to 
 Army Medical Officers of 10 years' standing and to all 
 young officers of the R.A.M.C. and Indian Medical Service 
 on joining. 
 
 He invited me to visit him at Millbank, and I was 
 much interested in what I noticed there. In addition to 
 seeing Sir David and Lady Bruce at work in their laboratory, 
 I inspected what Colonel Wardrop caUed his menagerie, 
 where rats, mice, rabbits and guinea pigs are kept for use 
 in^'connection with scientific research, an illustration of 
 which I noticed in a rat which was d5dng comfortably from 
 sleeping sickness. Later on Colonel Wardrop was appointed 
 Governor of Osborne, which is now a convalescent hospital 
 for officers in His Majesty's Forces. He again very kindly 
 invited me to spend a few days with him, a privilege which 
 I appreciated very highly, as it afforded me the opportunity 
 of enjoying the pleasure of inspecting a building and 
 surroundings of great historic interest. Colonel Wardrop and 
 his two daughters met me at Cowes and motored me to 
 Osborne House. The portion of the house occupied by 
 Colonel Wardrop, his wife and two daughters, contained 
 two rooms which were particularly interesting, as what 
 was his dining-room had been the night nursery and his 
 drawing-room the day nursery of Queen Victoria's children 
 when they were in residence at Osborne. It would occupy 
 too much space if I were to describe all the objects of 
 interest which I saw at Osborne, and the reflections which 
 passed through my mind during Colonel Wardrop's 
 engagement in his professional duties. I walked alone down 
 the broad walk to the shore of Osborne Bay as Queen 
 Victoria herself had done. I thought of the Royal and
 
 SIXTY-FOUR YEARS A DOCTOR 175 
 
 other distinguished persons whom she had entertained, and 
 the famous statesmen who had conferred with Her Majesty 
 at Osborne. 
 
 Inside the house are the State Apartments, and the 
 portion which is utilised as a Convalescent Home for Officers 
 of the Navy and Army. The State Apartments consist of 
 the dining-room, drawing-room, bLlliard-room and durbar- 
 room. The billiard-room is really part of the drawing-room, 
 from which it is divided by a very fine curtain. 
 
 The furniture, pictures, grand piano in the drawing- 
 room, and works of art, etc., in the State Apartments were 
 permitted by King Edward to remain there, and they have 
 been as far as possible retained in the position in which 
 they were originally placed. I had pointed out to me the 
 room above the dining-room in which Queen Victoria passed 
 away, and I was told that the blinds have remained down 
 ever since that sad day. 
 
 In front of the house are some beautiful terraced 
 gardens, and from the house the grounds slope down to the sea. 
 
 When I took leave of Colonel and Mrs. War drop and 
 their daughters at Cowes, I little thought that a near relative 
 of mine would soon after arrive at Osborne as a patient. 
 On October 9th, 1913, my nephew, George Lamont Hobbs, 
 major in the Connaught Rangers, was admitted to Osborne 
 House, shortly after being invahded home from India. 
 He left on December 16th, 1913, and spent Christmas in 
 Galway. He returned to Osborne about the middle of 
 February, and died there on June 2nd, 1914, aged 46. He 
 passed away in the presence of his wife, his mother (my 
 sister), and good Colonel Wardrop. 
 
 Colonel Wardrop was elected one of the House Surgeons 
 at the Preston Infirmary in 1877, and left in 1879 with as 
 good a record for efficiency and sociability as it was possible 
 for any house surgeon to obtain. On leaving the Infirmary 
 he joined the Military Service as a civil surgeon, and served 
 his country during the Zulu War. Subsequently he joined 
 the Medical Department of the Army and served in Egypt, 
 India and other places.
 
 176 SIXTY-FOUR YEARS A DOCTOR 
 
 During my visit to Osborne, Colonel and Mrs. Wardrop 
 motored me to the well-known Royal National Hospital for 
 consumption and diseases of the chest at Ventnor, Isle of 
 Wight, which was established in 1869 on the separate house 
 principle, and contains 177 beds. 
 
 Colonel Wardrop served two years in South Africa 
 after leaving Preston, including the Kaffir, Sekukani and 
 Zulu campaigns, and joined the Army Medical Service as 
 soon as he returned to England. He served 20 years in 
 various parts of India, and went to Khartoum in 1898, and 
 from there to the affair at Crete. He was nearly four years 
 at Millbank and nearly 10 years at Osborne, where he served 
 during the Great War. During the war he acted as 
 P.A.D.M.S. for the Isle of Wight, and between 5,000 and 
 6,000 officers passed through Osborne diiring his house 
 governorship. Colonel Wardrop received the A.C.B. and 
 C.V.O. during his service. He concludes his latest letter 
 to me by stating that he is not sure but that the happiest 
 part of his life was at the Preston Royal Infirmary. 
 
 MAJOR-GENERAL WARREN. 
 In June, 1899, I was requested by the St. John 
 Ambulance Association officials to entertain the Duke of 
 Newcastle from Saturday to Monday, on the occasion of his 
 visit to Preston to inspect a large number of nurses on the 
 North End football ground. As the Duke was unable to 
 fulfil his engagement, Major-General Warren acted as his 
 deputy, and it was a great pleasure to me to entertain 
 him. 
 
 On the Sunday morning he attended St. George's 
 Church with my sister whilst I was visiting my patients. 
 I invited Brigadier-General Brownrigg, who commanded the 
 Forces at Fulwood Barracks, to meet him at luncheon, and 
 in the afternoon I took them to Lytham, St. Annes, and 
 Blackpool. Like many other people, they were very much 
 impressed with their visit to these places. At Blackpool, 
 through the kindness of the Chief Constable, Mr. Derham, 
 who accompanied us, we were allowed access to the Tower,
 
 SIXTY-FOUR YEARS A DOCTOR 177 
 
 the Winter Gardens, and the Palace, which at that time 
 were closed on Sundays. 
 
 When I remarked to Mr. Derham that probably there 
 is not a finer ballroom than that at the Winter Gardens 
 in any part of the United Kingdom, he looked at me and 
 said, " There is not a finer ballroom in the world." 
 
 DR. H. DA VAN WETTON. 
 
 When I went to London in 1855, Mr. C. E. WilUng was 
 the organist at the Foundling Hospital Chapel, and he held 
 the appointment from 1848 to 1879, when he was succeeded 
 by Mr. Birkett Foster, son of the great painter. He was 
 followed by Dr. Davan Wetton, appointed in 1892, whose 
 acquaintance I made by taking a letter of introduction to 
 him from my nephew, Frederick Gregson Shuttleworth, who 
 at that time was assistant organist at St. Mary Abbotts, 
 Kensington, and since the death of Mr. Henry Bird, has 
 been the organist. Dr. Wetton had been Sir F. Bridge's 
 assistant at the Abbey, and my nephew one of his articled 
 pupils. Dr. Wetton explained the mechanism and showed 
 me all the arrangements in connection with the organ, which 
 was given by George Frederick Handel, who conducted a 
 performance there of the " Messiah " for the benefit of the 
 charity in the year 1749. 
 
 Shortly afterwards I invited Dr. and Mrs. Wetton to 
 spend a few days with me at Preston. Since then their 
 visit has been repeated on several occasions. During these 
 visits I had the pleasure of taking them to several places 
 in the neighbourhood : — ^Whitewell, Windermere, Rydal, 
 Grasmere, Ullswater, Morecambe, Blackpool, Lytham, St. 
 Annes, Fleetwood, Liverpool, Manchester, Southport, and 
 Colwyn Bay. Ever since then, when I had occasion to go 
 to London, I have attended the Sunday Service at the 
 Foundling Hospital Chapel. I enjoyed their society very 
 much. Mrs. Wetton is a charming, highly accomplished 
 lady, and a splendid pianist. Dr. Wetton possesses many 
 high musical distinctions. After our visit to Whitewell, on 
 his return to London, he composed a hymn tune, and
 
 178 SIXTY-FOUR YEARS A DOCTOR 
 
 christened it " Whitewell," and on the occasion of my visits 
 to the Foundling Hospital since that time, it has been a 
 great pleasure to me to hear it sung by the Foundling Choir. 
 Whenever I have known that Preston friends intended 
 to go to the Foundling Hospital I have given them one of 
 my address cards. On presenting this to Dr. Wetton they 
 have been very much impressed by his kindness and attention 
 to them. He has shown them the valuable pictures and 
 other objects of interest at the Foundling Hospital, and they 
 have returned home with very pleasant memories and a 
 desire on some future occasion to visit the Foundling again. 
 
 SIR GERMAN SIMS WOODHEAD. 
 
 Sir Sims Woodhead was my guest when he came to 
 Preston to speak at a three days' Conference of the National 
 Temperance Society. He was Professor of Pathology at 
 Cambridge since 1899. He was best known as the inventor 
 of the process of chlorinating drinking water for the British 
 troops during the war. It killed any germs that were in 
 the water, and so prevented the spread of disease. He was 
 a member of the Royal Commission on Tuberculosis in 1902, 
 and of the Executive Committee of the Imperial Cancer 
 Research Fund. He acted as Instructor of Laboratories 
 in Military Hospitals in the United Kingdom, and was 
 formerly Adviser in Pathology to the War Office, and was 
 knighted in 1919. He occupied a very high position in 
 being a Professor of Pathology at the University of Cambridge. 
 He interested his audience very much at the meeting of the 
 Temperance Society at Preston, by telling them of some of 
 his investigations in reference to the effect of alcohol on man 
 and the lower animals. His appeal to people to abstain 
 from taking alcohol was calculated to have a greater effect 
 than that of the ordinary temperance advocate. He took 
 a very great interest in the Research Hospital at Cambridge, 
 and I met him at dinner at Sir Clifford Allbutt's house at 
 St. Radegunde, Chaucer Road, Cambridge, on the evening 
 of the day on which I opened the Research Hospital. 
 
 I could write a very long list of medical men in Liverpool,
 
 SIXTY-FOUR YEARS A DOCTOR 179 
 
 Manchester, and Preston, whom I have known and with 
 whom I have been associated, but it would occupy too much 
 space if I were to do so. I will, therefore, confine myself 
 to those at present living. My acquaintance with some of 
 them has been slight, with some of them very intimate, but 
 I can truly say that I have received kindness and attention 
 from all of them. 
 
 Liverpool. — ^Alexander, C. B.; Barr, Sir J.; Bell, W. 
 Blair; Bickersteth, R. A.; Bickerton, T. H.; Bradshaw, T. R. 
 Briggs, H.; Bywater, H. H.; Caton, R.; Gemmell, J. E. 
 Glynn, T. R.; Hay, J.; Heaney, F. J. S.; Holland, C. Thurstan 
 Jones, Sir R.; Jones, T. C. Littler; Larkin, F. C; McAlister 
 C. J.; McKenna, R. W.; Newbolt, G. P.; Parker, Rushton 
 Paul, F. T.; Thomas, W. Thelwall. 
 
 Manchester. — Brockbank, E. N.; Burgess, A. H. 
 Bury, J. S.; Coates, W.; Dearden, W. F.; Donald, Archibald 
 Fitzgerald, G. W.; Leech, E. B.; Melland, C. H.; MiUigan 
 Sir W.; Moore, F. Craven; Murray, G. R.; Rayner, H. H. 
 Reynolds, E. S.; Smith, J. W.; Southam, F. A.; Steell, G. 
 Thorburn, Sir W.; Wilkinson, A. T.; Williamson, R. T. 
 
 I will only mention the Preston medical men to whom 
 I have applied for information in reference to surgical opera- 
 tions, and they are : — Doctors ColHnson, Derham, Duncan, 
 A. S. Holden, A. Rayner, Sykes, Turnbull Smith, and A. 
 Toulmin. There are 66 doctors in Preston, and I am on 
 friendly terms with all of them. 
 
 THE ROYAL ALBERT INSTITUTION, 
 LANCASTER. 
 
 In 1870 I was appointed Hon. Secretary of the Preston 
 Committee, and in 1916, a member of the Institution's 
 Central Committee. 
 
 In becoming associated with the committees of the Royal 
 Albert Institution I made some important additions to my 
 hst of friends, and became more familiar with the working 
 of this most benevolent institution. 
 
 The Roj^al Albert Institution was opened in December, 
 1870, for the care, education, and training of the improvable
 
 180 SIXTY- FOUR YEARS A DOCTOR 
 
 feeble-minded of all classes belonging to the seven northern 
 counties — Lancashire, Yorkshire, Cheshire, Westmoreland, 
 Cumberland, Durham, and Northumberland. Special accom- 
 modation is reserved for private patients both at Brunton 
 House and in the main buildings. 
 
 Accommodation has been provided for about 750 inmates, 
 and the arrangements comprise every convenience for the 
 specific treatment of the feeble-minded. The system of 
 training is designed to secure, by special means, the physical, 
 mental and moral improvement of the patients. 
 
 Besides the school instruction, training is given in a 
 great variety of useful occupations. The boys are taught 
 tailoring, shoe-making, basket-making, brush-making, book- 
 binding, weaving, cord-making, baking, joinery, mat-making, 
 cabinet-making, woodcarving, toy-making, and printing. 
 There are excellent means of outdoor employment, and 
 training in farm and garden work. The gkls are trained in 
 knitting, sewing, lace-making, hat-making, cooking, and other 
 household occupations, and in toy-making and laundry work. 
 
 The results of training are shown by the following 
 statistics : — Since the opening of the Institution in 1870, 
 3,863 patients have been admitted, nearly all of whom have 
 been considerably improved, some 10 per cent, having become 
 self supporting. 
 
 LANCASHIRE COUNTY CONSTABULARY. 
 
 When I retired from the ofhce of Headquarters Surgeon, 
 I received the following letter and the beautiful inkstand 
 which I have given to the Harris Free Library Museum, 
 and I have requested that it may be placed in the glass case 
 which contains the casket and the document conferring 
 upon me the Freedom of the Borough : — 
 
 [COPY] 
 
 Chief Constable's Office, 
 
 Lancashire Constabulary, 
 Preston, 
 Dear Sir Charles, 5th December, 1921. 
 
 I am forwarding on behalf of the Headquarters Staff of the Lanca- 
 shire Constabulary a small present as a token of our esteem and regard 
 for you.
 
 SIXTY-FOUR YEARS A DOCTOR 181 
 
 I hope you will accept it with our very best wishes, and at the 
 same time I should like to add that we are sending you this small 
 present, not only to you in your capacity as late Police Surgeon, but 
 also as a friend to all of us. 
 With kind regards. 
 
 Yours sincerely, 
 
 (Signed) H. P. P. LANE. 
 
 The following is the description given on the inkstand : — 
 
 Presented to Sir Charles Brown 
 
 BY the 
 
 Headquarters Staff 
 
 OF THE 
 
 Lancashire Constabulary 
 
 IN 
 
 Grateful Remembrance 
 
 of his 
 
 27 Years Service as Police Surgeon. 
 
 1921.
 
 ANECDOTES. 
 
 The Inebriate Schoolmaster. 
 
 A seedy-looking man called on me one day, at the request, 
 he said, of a benevolent lady whom I know, to ask for an 
 old suit of clothes. He told me that he was a schoolmaster 
 out of employment, and that he could get a good situation 
 if he had better clothes. Before I consented to help him, 
 I said that I feared he was in trouble owing to his intemperate 
 habits. His reply was, " It would be exceedingly wrong 
 in me, Sir, if I were to endeavour to conceal from you the 
 fact that my downward progress has been considerably 
 facilitated by an intemperate use of intoxicating liquor." 
 
 The Man who was not afraid to Die. 
 
 An old man who had suffered from chronic bronchitis 
 for several years, and was gradually approaching the end, 
 appeared much worse when I called to see him, and when 
 I asked him if any clergyman visited him, his reply was, 
 " No, and I am not afraid to die, if that is what you are 
 thinking about." I told him that I would ask one of the 
 curates of the Parish Church to visit him, as he was living 
 in that district. When I asked him why he was not afraid 
 to die, his reply was, " Because I know the burial service 
 off by heart." After the clergyman had been, the patient 
 said that he did not think much of him. But I said, " He 
 prayed with you and read to you." " Yes," was his answer, 
 " He did a bit of both." " He told me about a man who 
 went into a field and filled himself with husks." 
 
 Sir William Gull and the Clergyman. 
 
 Sir William Gull occupied one of the highest positions 
 in the medical profession in 1861. He, in conjunction with 
 the late Sir William Jenner, attended Prince Albert during 
 his illness, which ended fatally a few days before December 
 25th, 1861. 
 
 182
 
 SIXTY-FOUR YEARS A DOCTOR 183 
 
 A clergyman from the North of England called at Sir 
 William's house and asked if he could see the doctor. The 
 butler wished to know if he had made an arrangement to be 
 examined on a particular day, as if not, he would put his 
 name on the list, and Sir William might be able to see him 
 next week, but he was afraid it might be the week after. 
 The clergyman said that would not do at all, as he was only 
 in London for a day or two, and as he was not feeling very 
 well, he thought that Sir William Gull would just give him 
 a bottle of medicine which would set him right. 
 
 The Lady and the Hare. 
 
 The curate of one of the Preston churches received a 
 present of a hare. His wife and the maid servant did not 
 know how to prepare it for being cooked. One afternoon 
 a friend who called to see her remarked, " You look fatigued." 
 " Indeed I am," she replied, " for the servant and I have 
 been trying all morning to pluck the hare, and we have not 
 been able to make anything of it." 
 
 A Wealthy Man and His Will. 
 
 One of my patients, who died worth £150,000, had two 
 brothers who were both well off, but were anxious that my 
 patient should make a will, and wished me to try and per- 
 suade him to do so. I introduced the subject to him as 
 delicately as I could several times, without effect, and on 
 the last occasion when I did so he burst into tears and said, 
 " I don't know what to do with my money." 
 
 A Difference of Opinion about a very Red Face. 
 
 One day I had a discussion with a friend in reference 
 to a man who had a very red face, and whose colour was 
 believed by some to be due to excessive indulgence in alcohol, 
 but which I knew was not so caused, as the suspected person 
 was almost a total abstainer. My friend remarked, " When 
 I was at Oxford a discussion arose in reference to a similar 
 case, as to whether the redness was ' the rubicundity of 
 inebriety' or ' the roseate hue of health,' and it was decided
 
 184 SIXTY-FOUR YEARS A DOCTOR 
 
 that it is correct to say that if we judge merely from appear- 
 ances we may be mistaken." 
 
 A Dinner Table Mistake. 
 
 Some men who were unaccustomed to see a dinner table 
 laid out with finger glasses containing water and a small 
 piece of lemon, were dining together at the expense of a 
 friend who occupied a higher social position and to whom 
 they had rendered a service. One of them raised the finger 
 bowl to his lips and drank the contents, exclaiming to the 
 others, " You are not drinking your lemon soup. It is 
 excellent." 
 
 A Busy Solicitor. 
 
 A gentleman called one day at the office of a solicitor, 
 whose staff consisted only of a boy, and the following conver- 
 sation took place between them : — 
 
 " Is Mr. in the office ? " 
 
 " No, Sir." 
 
 " When will he be in ? " 
 
 " Please, Sir, I don't know. Sir." 
 
 " Where does he live ? " 
 
 " Please, Sir, I don't know, Sir." 
 
 " Where do you send his letters to ? " 
 
 " Please, there never is none, Sir." 
 
 The Rich Man and Salmon. 
 
 A gentleman ordered his butler one day to go to the 
 fishmonger's to purchase some salmon. On his return empty 
 handed, when asked, " Where is the salmon ? " he replied. 
 " Please, Sir, I did not get any, as I found that it was half a 
 crown a pound." The gentleman was very angry and said, 
 " Go back at once and bring me what I want. I can eat 
 salmon, but I can't eat half crowns." 
 
 Gout in the Stomach. 
 
 A man who was what is called a free liver, sent for his 
 medical attendant on account of a severe abdominal pain 
 from which he was suffering. He was rocking to and fro
 
 SIXTY-FOUR YEARS A DOCTOR 185 
 
 and pressing both hands on the front of his body, and 
 exclaimed, " Doctor, I think I am going to die. I believe 
 I have gout in my stomach." " Nothing of the sort," said 
 the doctor, "it is merely duck swimming about in port wine 
 in your stomach."' 
 
 How THE Appreciation of a Good Lunch was destroyed 
 BY Further Information. 
 
 An inspector of factories and a certifying surgeon had 
 been visiting a mill a few miles from town, when, on their 
 return homewards, they came up to a roadside inn. One 
 of them remarked, " I wonder if we could get some lunch 
 here !" and they agreed to try. The landlady, in reply to 
 their inquiry, said that she could let them have some liver 
 and bacon if that would do. As this was a dish which both 
 of them liked, they agreed to have it. Wlien the landlady 
 came for payment, one of them said, " We have enjoyed 
 our lunch very much. Do you often kill a calf ? " They felt 
 very uncomfortable when her reply was, " No, and we should 
 not have killed that if it had been sound." 
 
 A Foxy Case. 
 
 Many j^ears ago whilst waiting in the Assize Court at 
 St. George's Hall, Liverpool, for my turn to be called as a 
 medical witness, I heard the trial of a remarkable case, in 
 which I am thankful to say I was not engaged. A horse 
 dealer who had been a passenger in a train which had met 
 with a slight collision near Rugby, sued the London and 
 North-Western Railway Company for compensation for 
 personal injuries. His counsel, Mr. Chas. Russell (who 
 ultimately became Lord Russell of Killowen), after opening 
 the case in the usual way, put a series of questions to the 
 plaintiff in reference to his injuries, and his description of 
 them was confirmed by a medical man, who added the 
 information that as one of the results of the collision the 
 plaintiff's urine had contained blood. As soon as the plaintiff 
 and his doctor had finished their evidence, Mr. Samuel Pope, 
 who at that time was one of the leaders on tlie Northern
 
 186 SIXTY-FOUR YEARS A DOCTOR 
 
 Circuit, produced a letter, which was handed on to the witness 
 
 with the request that he would examine it and state if the 
 
 handwriting was his. The plaintiff was obliged to admit 
 
 that it was, and much amusement was caused when Mr, 
 
 Pope read aloud the contents of the letter, which were as 
 
 follows : — 
 
 My Dear Wife, 
 
 I have been in a railway collision near Rugby. Thank God, I 
 am not injured ; but, as I mean to have ;^1,000 out of the London 
 and North-Western Railway Company, I am lying in bed and doing 
 a httle foxing. 
 
 Upon hearing this Mr. Charles Russell jumped up and 
 said : — "I need scarcely assure your Lordship and the 
 gentlemen of the Jury that I knew nothing whatever of this 
 disgraceful business, and I am sure that the very respectable 
 firm of solicitors who instructed me were equally ignorant 
 of it, and I can have nothing more to do with the case." 
 The explanation of this extraordinary disclosure was that 
 there had been a family quarrel, and that the plaintiff's 
 brother-in-law, having in some way become possessed of 
 the letter, forwarded it to the District Superintendent of the 
 London and North-Western Railway at Liverpool, who 
 handed it to Mr. Samuel Pope, the counsel for the defendents. 
 I must not omit to mention that blood had been purchased 
 at a butcher's shop in Rugby for the alleged purpose of 
 applying it to the capped hocks of a horse, and it was supposed 
 that some of this had been mixed with some of the plaintiff's 
 urine for the purpose of making his alleged injury appear 
 all the more serious. 
 
 Another Foxy Case. 
 
 This case reminds me of another in which a family 
 quarrel led to a disclosure in the Assize Court, also causing 
 much amusement. A young woman who had been sHghtly 
 injured in a railway collision, sued the company for compensa- 
 tion. Amongst other evil consequences which were said 
 to have resulted from her injuries, it was asserted that " her 
 mind had become affected." Her brother, however, was 
 called as a witness on behalf of the raOway company, and
 
 SIXTY-FOUR YEARS A DOCTOR 187 
 
 he described how his sister had been instructed to act when 
 the company's doctor called to examine her. She was told 
 that she must " Act the gobbin and sken like the devil." 
 In Lancashire the word " gobbin " means a simple minded 
 person, and " sken " is another term for squint. 
 
 Sir William Wylde and His Parlourmaid. 
 
 Sir William Wylde was an eminent Ophthalmic Surgeon 
 in Dublin, and the father of Oscar Wilde. He invited me 
 to have lunch with him one Sunday in May, 1863. I arrived 
 at the station early and took a first-class ticket, thinking 
 that he would be sure to do so for himself. However, when 
 he arrived, he said, " Brown, what class are you going ? 
 I replied that I had taken a first, as I thought that he would 
 always travel first. " Oh, faith," he said, " I always go 
 third." We had not been many minutes at the table before 
 he turned towards the parlour-maid and said, " Mary, just 
 run next door and see if they will lend us the mustard." 
 This was Sir William's way of letting her know that she had 
 omitted to put the cruet stand containing vinegar, pepper, 
 and mustard on the table. Oscar and his twin brother who 
 appeared to be about 12 or 14 years of age, seemed to enjoy 
 the joke as much as I did. On another occasion I went with 
 Sir William Wylde to see his patients at the Ophthalmic 
 Hospital. A man appeared, clothed literally in rags and 
 tatters. Sir William looked at him, and standing with his 
 left eye closed, his right foot a few inches in advance of the 
 other, and his right forefinger pointed at the man, said, 
 " Now, my friend, when you have worn that suit a little 
 longer on a Sunday, I think you might take it for everyda3\" 
 
 A Horse Seventy Years Old. 
 
 The Vicar of a village about half a mile from a large 
 County Asylum paid a visit one day to the medical super- 
 intendent. On his way through the Asylum grounds he 
 passed a stable, the door of which was open, and through 
 which he saw a man cleaning a horse. The man touched 
 his cap and said, " This is a very old horse. Sir. It was
 
 188 SIXTY-FOUR YEARS A DOCTOR 
 
 at the Battle of Waterloo and all through the Indian 
 Campaign in 1857." On arriving at the doctor's house, 
 the Vicar, after an exchange of greetings, said, " Doctor, 
 you have a wonderful horse in your stable. I have calculated 
 as I have come along that it must be 70 years old." " How 
 do you make that out? " said the doctor. The Vicar replied, 
 " Because your groom told me that it was at the Battle of 
 Waterloo and all through the Indian Mutiny business." 
 He was surprised to hear that the man was not the doctor's 
 groom, but a harmless lunatic who assisted him in his work. 
 
 A Temperance Sermon. 
 
 A clergyman gave out as his text the words addressed 
 to Timothy by St. Paul, " Drink no longer water, but a little 
 wine for thy stomach's sake and thine often infirmities." 
 He began his sermon thus : — " There can be no doubt, my 
 brethren, that when this advice was given, St. Paul thought 
 that Timothy, who was a particular friend of his, was suffering 
 from some form of indigestion." 
 
 A Harvest Thanksgiving Sermon. 
 
 At a very small village church, where the congregation 
 consisted chiefly of farmers, a thanksgiving service was held 
 after an exceptionally wet summer. The clergyman com- 
 menced his remarks with the following words, " The dis- 
 tribution of rain on the face of the earth, my brethren, is 
 very uneven ; for instance, in the Fiji Islands there is so 
 little rain that an umbrella maker could not make a decent 
 living." 
 
 In another harvest thanksgiving sermon, when alluding 
 to a hot summer, he said, " My friends, there must be 
 strange sights in tropical countries, particularly in the 
 jungle, where may be seen the subtle monkeys frolicking 
 in the branches, and the unwieldy elephants wallowing 
 in the mud." 
 
 The Prisoner Who Wrote Sermons for Clergymen. 
 A prison doctor who took an interest in the antecedents
 
 SIXTY-FOUR YEARS A DOCTOR 189 
 
 of prisoners, and who also had the reputation of being in- 
 quisitive about other people's affairs, asked a superior looking 
 individual how he earned his living before he got into trouble. 
 The doctor knew that he was in prison owing to his intem- 
 perate habits. The man hesitated in giving a reply, but 
 ultimately said, " I don't like to tell you, sir, but I get my 
 living by writing sermons for clergymen." 
 
 A Nonagenarian and His Halfpenny. 
 
 The old gentleman had two distant relatives spending 
 the week-end with him. About midnight on the Saturday 
 evening, they were enjoying their cigars in the room which 
 was beneath his bedroom. They became rather uneasy 
 when they heard him pacing the floor ; and fearing that he 
 might be ill, one of them went quietly upstairs, knocked 
 at liis bedroom door, and expressed the hope that he was 
 not ill. " Oh, no," he replied, " I am not ill, but my accounts 
 won't balance by a halfpenny, and I don't intend to go 
 to bed until they do." The venerable nonagenarian gave 
 £6,700 about ten years before he died for the building and 
 endowment of a church, and bequeathed £20,000 to the 
 Infirmary. 
 
 The Future of Some Medical Students. 
 
 A small group of students at King's College, London, 
 were having a friendly chat, when one of them suggested 
 that it would be interesting to know what their respective 
 views were in reference to the special department to which 
 they would like to be attached, when they commenced, 
 or a few years after they had commenced, private practice. 
 
 One of them said, I aspire to be an eminent ophthalmic 
 surgeon ; another that he would devote himself to diseases 
 of the ear ; another would restrict his practice to cases 
 of throat and nose disease ; whilst a fourth said that he 
 should like to have nothing to do with diseases below the 
 waist. One of these gentlemen subsequently became the 
 personal medical attendant of a member of the Royal 
 Family.
 
 190 sixty-four years a doctor 
 
 An Unpleasant Sequel to a Good Dinner, 
 
 One day I was at the Preston Station when a train 
 from Blackpool arrived, and I saw a gentleman whom I 
 knew leaning out of a carriage window and beckoning to 
 me. The platforms, at the period to which I allude, were 
 below the level of the long wooden step of the railway 
 carriage, and you had to be very careful in getting in and out. 
 On going up to him he said, " Doctor, I wish you would 
 help me and let me have your arm as far as West Cliff. 
 I have been dining with the Directors of the Clifton Arms 
 Hotel, Blackpool, and my legs are drunk, but my head is 
 all right." I was glad to hear afterwards that his difficulty 
 in walking and fear of falling were only temporary troubles, 
 and passed off as soon as he had enjoyed a good sleep. He 
 was very emphatic in assuring me that his head was all right, 
 and I believe that it was. 
 
 The New Vicar and the Old Lancashire Verger. 
 
 The old verger was seen by the new Vicar to take 
 half a crown from the collection plate before presenting it 
 at the altar rails. After service the Vicar spoke to the 
 verger, saying how sorry he was that he should find him 
 guilty of such an act. For a moment the verger was 
 bewildered at the charge ; then he said, when light dawned 
 upon him, " You must not think that I have taken the 
 money for myself. That half-crown is a bait. I have led 
 off with it for the last fifteen years." 
 
 The Labourer and Socialism. 
 
 A Lancashire laboiu^er was once asked to carry a banner 
 in a Sociahst procession, and the pay being satisfactory 
 he consented. On the way he got into conversation with 
 a " Comrade " who walked beside him, and asked him for 
 some information about the new crusade. " Well," the 
 Socialist said, " We contend that it is unjust for one man 
 to have more than another, and we are going in for all 
 sharing alike." " Oh ! I see, and a very good idea too." 
 The men were silent for a little while, and then the man
 
 SIXTY-FOUR YEARS A DOCTOR 191 
 
 carrying the banner said, " And how much do you reckon it 
 would be apiece ?" " Well," said the other man, " Someone 
 has calculated it at £A1 16s. ll^d." " Forty-seven pounds," 
 exclaimed the man. " Here, take hold of this blooming 
 banner ! I have £80 in the Co-operative Society ! " 
 
 A Lancashire Collier and His Dog. 
 
 A Lancashire collier was scolded by a clergyman for 
 keeping a dog at a time when work was bad to get and food 
 was scarce. " Look how much better it would be for you 
 and your family if you sold your dog and bought a pig ! " 
 " Yes, a bonny fool I should look ! I could not go ratting 
 with a pig." 
 
 The Fly as Instructor. 
 
 We all know the danger which may be caused by a fly. 
 It is reputed to be a conveyor of typhoid fever and tuber- 
 culosis germs, and we are aware that it may come direct 
 from a manure heap and settle on our milk and meat. We 
 are all familiar with the disagreeable tickling which it causes, 
 especially on a bald head, but we have never regarded it 
 as an instructor. Dr. Walshe, one of the physicians to 
 University College Hospital, London, and reputed to be 
 a most minute and careful observer, was going round one of 
 his wards with a number of students, when he said to his 
 clinical clerk and note taker, " Write down, ' Fly crawls 
 over patient's eyelids, patient does not wince.' " And some 
 of the students laughed, but Dr. Walshe pointed out to 
 them that there was nothing to laugh at. The fact that 
 the patient did not wince showed that he was in 
 a state of profound insensibility, and he reminded them 
 of what they had been taught in reference to reflex 
 actions. 
 
 An Operation in the Night Under Difficulties. 
 
 I was required to perform an operation for the relief 
 of a strangulated hernia in the night, in a cottage house 
 about nine mUes from Preston. The patient was being put
 
 192 SIXTY-FOUR YEARS A DOCTOR 
 
 under the influence of cliloroform, and the anaesthetist said 
 he was ready. Upon touching him with the knife, he raised 
 his knee and sent the candlestick holding a tallow candle, 
 the only light we had, up to the ceiling. We were obhged 
 to wait until the candlestick came down, relight the candle, 
 and then resume the operation. The case was a most un- 
 promising one, as the hernia was very large and the operation 
 had been delayed, but the man made a complete recovery. 
 I heard nothing more of the case from the medical man 
 under whose care he was at this period, but about six weeks 
 afterwards the man called at my house one Saturday in his 
 Sunday clothes to see me. He said, " Don't you know 
 me, Doctor ?" I replied that I could not at the moment 
 remember, but when he told me that he was the man who 
 I had cut in the night six weeks before, I had a distinct 
 recollection of the whole incident. 
 
 The Judge and the Doctor. 
 
 Several years ago a railway compensation case was 
 being tried at the Liverpool Assizes, when the Company's 
 doctor gave evidence which was very strongly opposed to 
 the statements made by the plaintiff and his friends, when 
 the Judge said, " Am I to understand, doctor, that you con- 
 sider the plaintiff shamming ?" The doctor replied, " I beg 
 your Lordship's pardon, but we have no such word as 
 ' Shamming ' in our medical vocabulary." 
 
 A Mistaken Surgeon and Some Chairs. 
 
 A very distinguished surgeon visited an elderly gentle- 
 man who was supposed to be suffering from malignant 
 disease in the abdomen. He examined the patient very 
 carefully, said that he could not possibly recover, and that 
 he did not think he would live more than three months. 
 On taking leave of one of the relatives at the front door, 
 he expressed his admiration for some chairs which he saw 
 there, and said, " I shall be much obliged if you will let me 
 know when the sale takes place." The gentleman lived 
 a few years after the occurrence of this incident.
 
 SIXTY-FOUR YEARS A DOCTOR 193 
 
 A Doctor's Grace. 
 
 At a dinner where the host was noted for his ingenuity 
 as an amateur chef in serving up " rabbit " in all conceivable 
 forms, a witty Preston medical practitioner, pressed to 
 say grace, delivered himself of the following invo- 
 cation : — 
 
 " Of rabbits hot, of rabbits cold, 
 Of rabbits young and rabbits old. 
 Of rabbits tender and rabbits tough, 
 We thank Thee, Lord, we've had enough." 
 
 A Loss OF £10,000. 
 
 A friend of mine called one day to tell me that his father 
 had left him £10,000. I congratulated him, and expressed 
 the hope that he would take care of it. His reply was that 
 he would either double it or lose it. My caution was 
 evidently necessary, but unfortunately it was not acted 
 upon. A few years afterwards he called on a relative of 
 mine for an order for some goods for which he was an agent. 
 She got into conversation with him on business in general, 
 and asked him if he had ever read a little book called "How 
 a Penny became £1,000." He gave a hearty laugh, and 
 said that he did not know how a penny became £1,000 but 
 he knew very well how £1,000 became a penny. 
 
 Dr. Brandt and his Breakfast. 
 
 A Dr. Moore came down from London in 1853 to be 
 House Surgeon at the Preston Dispensary. The morning 
 after his arrival he saw no signs of breakfast. He rang the 
 bell, which the page boy answered, and expressed surprise 
 when the doctor told him he wanted some breakfast. The 
 boy asked him what he would like to have, and he replied, 
 " Some toast, and an egg, and some coffee, or what other 
 House Doctors had usually had." The boy rephed that 
 Dr. Brandt never had any proper breakfast, but used to 
 have some bitter ale and toasted cheese about 12 o clock 
 before he went out to see his patients.
 
 194 SIXTY-FOUR YEARS A DOCTOR 
 
 A Discouraging Commencement. 
 
 A doctor who became one of the most distinguished 
 consulting physicians in Lancashire and Chesliire told me 
 that when he had completed his education at the Hospital 
 and University he went into lodgings to commence private 
 practice. At the end of a fortnight he had not had a single 
 patient, and began to feel rather depressed. One day when 
 he was looking out of the window, his spirits were raised 
 by seeing a well-dressed man coming along the street and 
 stopping at the door of the house in which he was living. 
 He adjusted his collar and tie, and was looking forward to 
 the pleasure of having his first patient, when the man said, 
 " Please, sir, I have called to see if I may collect some of 
 your bad debts." 
 
 A Rich Man and His Friend. 
 
 A rich man who lived very freely invited a friend to dine 
 with him at his house near a village which was several miles 
 from a railway station. 
 
 I don't know how long the friend remained at the 
 dinner table, but it is reported that the influence of what 
 he indulged in was such as to render him unable to success- 
 fulh' resist the treatment to which he was subjected. This 
 consisted in shaving off the thick moustache and bushy 
 whiskers on one side of his face, and sending him in this 
 condition to the railway station. 
 
 The case reminds me of what I once read in the Second 
 Book of Samuel, and the tenth chapter, which describe 
 similar treatment the servants of King David received when 
 they were sent by their master to comfort Hanun, on the 
 death of his father Nahash, King of Ammon : — 
 
 1. And it came to pass after this, that the king of the children 
 of Ammon died, and Hanun, his son, reigned in his stead. 
 
 2. Then said David I will shew kindness unto Hanun the son 
 of Nahash, as his father shewed kindness unto me. And David sent 
 to comfort him by the hand of his servants for his father. And David's 
 servants came into the land of the children of Ammon. 
 
 3. And the princes of the children of Ammon said unto Hanun 
 their Lord, Thinkest thou that David doth honour thy father, that he 
 hath sent comforters unto thee ? Hath not David rather sent his 
 servants unto thee, to search the city, and to spy it out, and to over- 
 throw it ?
 
 SIXTY-FOUR YEARS A DOCTOR 195 
 
 4. Wherefore Hanun took David's servants, and shaved ofiE 
 the one half of their beards, and cut off their garments in the middle, 
 even to their buttocks, and sent them away. 
 
 5. When they told it unto David, he sent to meet them, because 
 the men were greatly ashamed ; and the king said. Tarry at Jericho 
 until your beards be grown, and then return. 
 
 I read the above to my friend Dr. x\rthur Rayner, and 
 was very much interested when he told me the following 
 story : — 
 
 " I was on that road from Ammon to Jericho on the 
 Sunday prior to Christmas Day, 1918, and lunched on the 
 far bank of the Jordan in blazing sunshine, with a Padre 
 of our unit of the R.A.M.C. and an Arab in the employ of 
 our Intelligence Department. In the afternoon we drove 
 up the hill road, alongside the magnificent Wadi Kelt, where 
 EUjah was fed by the ravens, into Jerusalem. That night 
 I heard the Christmas carols sung in the English Cathe- 
 dral in Jerusalem." 
 
 THE END.
 
 UC SOUTHERN REGIONAL LIBRARY FACILITY 
 
 A A 001 418 087 1