THE MEDICAL MEN OF TRING
1800-1939
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Operating theatre c. 1900, Metropolitan Free Hospital, London.
 


INTRODUCTION


From time to time we receive papers written by Tring residents, both past and present, dealing with various aspects of Tring’s history.  One such paper, MEDICINE IN TRING – A SHORT HISTORY, was written by Dr. David Thallon who had been a general practitioner in the town.  When David set to work on his paper he discovered that the practice records on which he planned to base his research had been lost, probably in 1988 when the surgery moved from No. 23 High Street to its present location at Rothschild House.  Thus, what David was able to commit to paper was confined to what he and his colleagues could recollect.

 

No.23 High Street, for many years a doctor’s surgery.


When I first read
David’s paper, some 20 years had elapsed since its publication and in that time more information had become publicly available courtesy of the Internet.  I though that with such a marvellous resource at my disposal it might be possible to use it to extend David’s account to cover a wider period of history with, perhaps, more detail.

To some extent I was correct.  With the help of old periodicals, newspapers and trade directories I have been able to identify most of those who practiced medicine in the town during the period preceding that covered in David’s paper (with some overlap).  However, when it came to describing the doctors as individuals, I found their personal information sadly lacking.  Sometimes a little could be unearthed from notices of appointments and obituaries, but I was able to uncover few of these.  The result is that nearly all those I refer to in this paper remain strangers.

Likewise, the medical information that finds its way into the public domain does not for the most part refer to a general practitioner’s daily workload, for what transpires between doctor and patient is confidential, and rightly so.  Such information would at any rate be unlikely to be of interest to the local press.  However, one can gain some idea of the work of those I refer to from the medical information that is published.  This comes almost entirely from newspaper reports of the hearings in the coroners’ courts, criminal courts and at town council meetings where the debate occasionally touches on matters of public health.  Thus, using this somewhat skewed information it is possible to say something about medical matters in the town, such as cases of smallpox, rabies, tetanus and diphtheria which, thankfully, are now mostly matters of history.

Although this paper includes some information on insanitary housing conditions in the town, the subject of public health is dealt with more fully in Public Health Comes To Tring.


Ian Petticrew

September 2012



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CONTENTS

THE EVOLUTION OF MEDICAL CARE IN THE 19th CENTURY


QUACKS, SURGEONS AND DOCTORS:


Bartholomew Rolls
John Lloyd
William Firth
Arthur Ballie

Robert Jeninges Moody
Peter Richard Dewsbury
Edward Pope
Charles Percy Green Townsend
Richard Nicholson Lipscomb
Edwin Joseph Le Quesne
James Brown
William Ward Anderson
Charles Edward O’Keeffe
Henry Norman Knox
Edward Middleton-Brown



MEDICAL OFFICERS OF HEALTH:

Charles Edward Saunders
William Gruggen
Malcolm Gross


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THE EVOLUTION OF MEDICAL CARE IN THE 19th CENTURY

 

Bleeding a patient

By the end of the 18th Century (and for many years thereafter) smallpox, typhus and tuberculosis were endemic, and cholera alarmingly epidemic.  Medical care was a combination of chance and quackery.  Treatments were mainly botanical, although preparations that contained phosphorous and heavy metals such as mercury, arsenic and iron were also popular.  Local doctors - in this era generally referred to ‘surgeons’ - might recommend a ‘change of air’ together with vomiting and laxatives and/or the old favourites of bleeding or leeches.  Yet a century later medicine administered by professionally competent practitioners would be available in a form recognisable to anyone today - hospitals, stethoscopes, antiseptics, x-rays, etc.

Broadly speaking, three main branches of medicine had evolved with some overlap between them.  ‘Physicians’ (who were rather thin on the ground, especially in the provinces) advised and prescribed medications, ‘apothecaries’ compounded and dispensed those remedies, and ‘surgeons’ performed all physical intervention from bloodletting to amputation.  Of the three, physicians were held in the highest esteem because they were university trained and held a degree in medicine.  The possession of this degree entitled them to the title of ‘Doctor of Medicine’ or simply ‘Doctor’.

At this time there was no university training for the physicians’ less eminent brethren, the surgeons, who acquired their knowledge through serving apprenticeships to experienced surgeons.  Nevertheless surgeons organized themselves into trade guilds, and although earlier guilds existed, the roots of today’s practice stem from the formation in 1745 of the Company of Surgeons.  In 1800 this company was granted a Royal Charter to become the Royal College of Surgeons in London,  and it became customary for surgeons to take the examination for Membership of the Royal College of Surgeons and put MRCS after their name.  However, because qualification did not result in the award of a university degree, licentiates could not style themselves ‘Doctor’ and so continued to be addressed as ‘Mr.’, a tradition that continues to the present day with female surgeons styling themselves ‘Mrs.’, ‘Miss’ or ‘Ms.’ as appropriate.

Regulation of the medical profession in the U.K. - leading to what in modern terms we would recognise as ‘general practitioners’ (GPs) - followed the passing of the Apothecaries Act (1815) described as “An Act for better regulating the Practice of Apothecaries throughout England and Wales.” 
The Act made it compulsory for all new entrants to general practice to acquire the Licence of the Society of Apothecaries (LSA). It not only introduced compulsory apprenticeship, but required apprentices to receive instruction in anatomy, botany, chemistry, materia medica [1] and “physic” in addition to gaining 6 months’ practical hospital experience.   The process could begin at age 14, but the minimum age for sitting the LSA examination was 21. [2]  Training typically took 7 years to complete, with those completing the process successfully gaining the qualification ‘Licentiate of the Society of Apothecaries’ (LSA).  A large majority of general practitioners, however, having acquired the LSA qualification also acquired the MRCS, so that the dual qualification MRCS LSA gradually became that of the general practitioner.

Oddly, just as it became compulsory for generalist medics to gain the LSA qualification it seems they largely stopped calling themselves ‘apothecaries, preferring instead to use the term ‘surgeon,’ while the ‘apothecary’ gradually assumed the modern term ‘chemist’ or ‘pharmacist.’  But despite the requirements of the 1815 Act, medical training remained disparate.  Thomas Bonner noted that “The training of a practitioner in Britain in 1830 could vary all the way from classical university study at Oxford and Cambridge, to a series of courses in a provincial hospital, to ‘broom-and-apron apprenticeship in an apothecary’s shop.’” [15]



No significant advances were then made until 1858, when the Medical Act established a recognisable form of healthcare regulation.  The Act’s overall aim was “to regulate the Qualifications of Practitioners in Medicine and Surgery.”  It established the ‘General Council of Medical Education and Registration of the United Kingdom’ (‘General Medical Council’ or GMC) as a statutory body and required it to create and publish an annual register of those with specified qualifications who were entitled to practise medicine or surgery (those in practice since before 1815 qualified automatically).
[9] The first official annual Medical Register showing place of education and qualification was printed in July 1859.  Any person not on the Register (including anyone struck off) who was practising as a physician, surgeon, doctor or apothecary was liable to a heavy penalty.


The Medical Register entry for Edward Pope of Tring listing his qualifications;
Member of the Royal College of Surgeons England (1834) and
Licentiate of the Society of Apothecaries, London, 1834.
In today’s terms Pope would be considered a general practitioner.


Thereafter medical training became more formal with the establishment of medical schools, while the number of doctors increased considerably, from 14,415 physicians and surgeons in England and Wales in 1861 to 35,650 in 1900.   Because the LSA did not cover surgery, it became the norm at the end of an apprenticeship for surgeon-apothecaries to take the Royal College of Surgeon’s membership examination (MRCS) at the same time as the LSA.  So the main qualifications that dominated the profession in the 19th century became, typically, LSA and MRCS for a generalist (the precursor of our present day family doctor); and typically MD (a university graduate in medicine) and FRCS (Fellow of the Royal College of Surgeons) for the increasing number of hospital based specialists in medicine or surgery respectively.

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QUACKS, SURGEONS AND DOCTORS
 

The Quack.

Newspapers of the Georgian and Victorian era often contained a smattering of advertisements for bizarre medications.  The quacks selling these products sometimes colluded with newspaper publishers, who not only ran the vendors’ advertisements in their pages, but often - for a cut of the profits - sold the remedies on the printers’ premises.  An example of quackery occurred in December, 1790, when an advertisement appeared in the Northampton Mercury that commenced as follows:


HYDROPHOBIA:
or, a cure for the bite of a mad dog.


PAUL NEWENS, of Wing, in the County of Bucks, is the sole preparer of a medicine that has never, in any instance, failed to eradicate the dreadful Malady occasioned by the bite of a mad dog, and which has been prepared with universal success for these last forty years and upwards, by the said Paul Newens . . . .


The rabies advertisement - for rabies was the disease in question - goes on to claim that . . . .


ELIZABETH KEMPSTER, servant to Mr. William Stevens, of Marsworth, farmer, had every appearance of hydrophobia, but on Paul Newen’s medicine being administered, was in the course of four hours entirely released and cured.


The advertisement concludes with the names of three individuals able to testify to the efficacy of this miracle remedy, one of whom was “J. R. Fawcett, surgeon of Tring.”  Fawcett was probably as bogus as the remedy, for I can find no further mention of him; but bogus or not, Fawcett is the earliest name connected with medicine in the town to appear in the press.  Today, the promotion and advertising of medicinal products in the U.K. is governed by advertising laws and the Human Medicines Regulation 2012, which is enforced by an agency of the Department of Health and Social Care, the ‘Medicines and Healthcare products Regulatory Agency’.


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BARTHOLOMEW ROLLS


It is very likely that there were earlier medical practitioners in Tring - for instance Tring’s burial register records that “Mary the wife of Jno. Lacy Dr. in Physicke buried March 16th” (1710 or 11) - but John Lloyd is the first I can trace about whom anything at all is known.  On the 17th April, 1797, it was recorded in the Tring Vestry Minutes that “The Vestry have agreed to give Mr. Rolls Surgeon thirty pounds for the year for all cases of Physic and surgery for the poor.”  Some years later a notice appeared in the London Gazette, the official public record, to the effect that . . . .


“The partnership lately carried on between Bartholomew Rolls and John Lloyd [below], of Tring, in the Country of Hertford, Surgeons, Apothecaries, and Man-Midwives, is this day dissolved by mutual consent, as from the 10th April last; and all accounts relating thereto will be settled by the said John Lloyd, who will in future carry on the above Professions in Tring aforesaid, on his own account. Witness our hands this 5th day of May 1815.”


Other than a brief mention in Tring’s Vestry Minutes, no record of Rolls’ work in Tring appears to have survived.  However, an impression of one aspect of his work – also shared by others referred to in this paper – comes from his appearance as an expert witness at a coroner’s hearing where cause of death needed to be established.  This case concerned Sidney Sadler, a printer, who died following a pugilistic contest
in the Islington area of London.  Sadler, reputed to be a quarrelsome individual, had challenged one John Watts to fight, a challenge that Watts accepted.  Having fought a dozen rounds, Sadler received two blows, one being to the throat, after which he fell to the ground.  Having by then lasted half an hour, the contest finished.  Later that evening Bartholomew Rolls was called to attend to Sadler, whom he found sitting in a chair in a public house “quite dead”.  Rolls then . . . .


“. . . . opened a vein in each arm, and then the temporal artery.  On opening the body, he found the marks of a blow (not severe) on the left side; on opening the head, he found that one of the arteries of the brain was ruptured, and a great effusion of blood, which he considered produced apoplexy.

Coroner. ― Did that rupture proceed from a blow?

Witness
[Rolls]. ― It is impossible to say ― it might have proceeded from a blow; or passion would have produced the same effect.

Juror. ― Would the blows on the jaw have produced the same effect?

Witness
[Rolls]. ― No, certainly not; the body was in a very healthy state, and they having fought on grass I am inclined to think his death was caused by apoplexy . . . .

. . . . The Jury then retired to view the body, and, after some discussion, returned the following verdict: ― ‘The deceased died of apoplexy, caused by irritation of mind in fighting.’”

Morning Advertiser 23rd October, 1823


On the 8th July, 1826, it was announced in the deaths column of the Northampton Mercury . . . .


“Lately, in the 58th years of his age (at the house of his son in law, Mr. Cheney, Aylesbury), Bartholomew Rolls, Esq. of Pentonville, Middlesex, formerly surgeon of Tring Herts. ― He was greatly respected in life, and his death is much lamented by his family and friends.”


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JOHN LLOYD

 

The grave of John Lloyd, surgeon, Tring Parish Church.


At the front of Tring Parish Church on its western side stands a weathered gravestone that bears the barely legible inscription . . . .


“Sacred to the Memory of John Lloyd Surgeon of this Town who died November 12th 1825 aged 39 years leaving a Widow and six Children to lament his irreparable loss.

This stone was erected by a few friends to whom his professional Talent and private Virtues had justly endeared him.


Lloyd’s headstone, having been erected “by a few friends”, gives a hint that he might have been living in straightened circumstances at the time of his death, a suspicion strengthened by an entry in the London Gazette (22nd February, 1817) requiring Lloyd - “Surgeon, Apothecary, Dealer and Chapman” - to appear at the Guildhall, London, there to make a full disclosure of his estate and effects.  The notice also invited Lloyd’s creditors to come prepared to prove their debts, for he had been declared a bankrupt - that said, the Gazette announced his discharge a few weeks later.  What little is known about Lloyd was that he had been in partnership with Bartholomew Rolls at Tring, a partnership that was dissolved in 1815, while his death notice refers to him being “a very eminent surgeon, formerly a partner in the firm of Messrs. Williams and Lloyd at Brecon.”

In the case of Lloyd, Williams and Bartholomew Rolls it’s difficult to know exactly what training and skill their use of the description “surgeon” implies.  One can be sure that surgery, both then and now, involved cutting into the body, but there the comparison with today’s practitioners ends.  What knowledge surgeons of the time had of surgical procedures will have been acquired through apprenticeship to a surgeon, who in their turn had also acquired their knowledge through on-the-job-training.  In this context it is interesting to note that Lloyd and his erstwhile partner Williams had themselves advertised for such an apprentice . . . .


Hereford Journal, 25th January 1809.


The 1823 edition of Pigot’s directory for Tring lists two surgeons, William Firth and John Lloyd under the heading ‘Professional’, while the 1825 edition introduces the heading ‘Surgeons’ under which are listed two partnerships, Firth & Ballie, and Lloyd & Dewsbury.  Although not shown as being in partnership it appears that on at least one occasion Firth and Lloyd worked together:


“The last week has added two cases to the many incidents which have occurred on the Grand Junction Canal [later renamed the Grand Union Canal].  A woman and her daughter, on their way to Uxbridge in a boat, were, in consequence of the boat striking violently against the sill of a lock, thrown down with violence, and a quantity of nails in bags falling upon them, they were severely bruised, and the woman’s wrist so dreadfully dislocated, that amputation seemed indispensable.  Mr Firth, surgeon of Tring, however, with a laudable desire to preserve the limb, called in the assistance of Mr. Lloyd, and the dislocation was reduced, and hopes are entertained of the poor woman doing well.  The girl, beside suffering very severe bruises, was very near losing the sight of one of her eyes, a nail having penetrated just under it.”

Evening Mail, 1st November 1824


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WILLIAM FIRTH


I have been unable to discover anything about William Firth, other than his entries as a surgeon in the 1823 and 1825 editions of Pigot’s Directory for Tring. 
The Morning Herald contains a report of Firth attending the victim of a road traffic accident . . . .


“On Saturday evening last, about nine o’clock, a son of Mr. Walter, of Wilstone, accompanied by a labouring man of the name of Archer, were proceeding from Tring towards Wilstone in a taxed cart.  The horse took fright and ran away to the top of the bridge, crossing the Grand Junction Canal at Little Tring, when the back tree of the harness gave way, and they were both precipitated out of the cart with great violence down a steep hill.  Young Walter was thrown against some railings, and fortunately escaped with only a bruise in the side, from the effect of which he is recovering; but Archer pitched on his head upon the ground, and the wheel of the vehicle went over his leg; his scalp was cut open in a dreadful manner, and he was taken up senseless, and apparently dead, the wound bleeding profusely; however, he revived, and by the prompt assistance of Mr. Firth, a surgeon of Tring, was sufficiently restored to be conveyed home, where he now lies, suffering dreadfully from the accident, but great hopes are entertained of his recovery.”

Morning Herald, 25th August, 1825


I was unable to locate anything further about this accident. As for Firth and his partner Ballie, neither  appear in the 1839 edition of Pigot, the next edition available to me.


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ROBERT JENINGES MOODY


In Pigot’s directory for 1839,
under SURGEONS appears one  “Moody Robt. Jeninges” whose practice was at Frogmore House (once located in Frogmore Street, Tring, long-since demolished).  Moody appears to have been born in Great Missenden on the 26th August 1807, married Charlotte née Cutler, and died at Tring in January 1842.  The National Archives holds the will of one Robert Jeninges Moody,  “Druggist of Great Missenden, Buckinghamshire,” but dated 1st June 1842.

Whether these references relate to the same person I cannot say, but I can find no other information relating to a surgeon of that name practicing in Tring.


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ARTHUR BALLIE M.R.C.S.


In June, 1830, Tring surgeon Arthur Ballie attended Samuel Budd, the victim of a road accident possibly caused by his carthorse shying.  Budd later died of his injuries.  In the absence of any method for assessing the extent of
the victim’s internal injuries, the press report of the inquest illustrates both the surgeon’s speculative diagnosis and the lack of any effective treatment in his repertoire:

 
An inquest on the body of Samuel Budd, was held on Wednesday, 23rd June [1830], before F. J. Osbaldeston Esq., at the Rose and Crown Inn, Tring . . . . Job Nutkins said he works for Mr. Stevens, Tring Grove.  Knew deceased; saw him alive on Monday morning, about seven o’clock, sitting up on the road.  Saw a cart lying on the road; the cart had been turned over on the near wheel; the horse was about six yards from the cart; the shafts of the cart were broken . . . . deceased was about five yards behind the cart . . . . spoke to deceased, but he did not answer; there was blood on his temples, though not much . . . .

Mr. Arthur Baillie, surgeon, examined [by the coroner], said he was sent for about seven on Monday morning to see deceased who was at his own cottage in bed.  Deceased complained of pain in his chest, and stomach; his breathing was very laborious.  Witness [Baillie] found a great depression in the lower part of the sternum; and a fracture of the large rib on the left side.  There were also slight marks on the left side of the head; but not sufficient to produce death.  Witness was of the opinion that the concussion of the chest produced death.  Deceased’s extremities were cold.  Witness gave him some brandy to stimulate him and subsequently bled him, but he gradually got worse, and died about nine yesterday morning.  Verdict accidental death.”

Bucks Gazette, 26th June 1830


Ballie appears again in the coroner’s court in September 1831 in a case reported in the Bucks Gazette that illustrates how helpless the surgeons of the time were at treating serious injury.  The circumstances of the death of Thomas Lovett are summed up in the verdict of the coroner’s jury:


“The jury returned a verdict in substance as follows: ‘That the said Thomas Lovett, on the 1st Sept., 1831, received a mortal wound of the depth of four inches, and of the breadth of one inch, in his left thigh, by a loaded gun, which he had been carrying when in the act of sporting, having gone off accidentally, and the contents thereof having penetrated his thigh, of which wound the said Thomas Lovett on the said 1st Sept. died.’  The verdict was accompanied by this observation - ‘But the jury are of the opinion that too large quantities of opium were injudiciously administered to the said Thomas Lovett.’”

Bucks Gazette 10th September, 1831


Following the gunshot injury, Lovett was taken to his house and Ballie was sent for.  Two other surgeons, Ayckburn of Wendover and Rumsey of Chesham, arrived later.  Lovett, who complained of great pain, had received a large lacerated wound on the back of the thigh.  Ballie stated to the coroner that:


“On introducing my fingers into the wound, I found it plugged up with coagulated blood, and the thigh bone was shattered, the upper portion of which protruded through the wound . . . . the patient complained of extreme pain; and as soon as I could procure pillows, I placed the limb in a more comfortable position. . . . The deceased repeated his wish to have something administered to him to ease his pain: I sent home for a draught, directing thirty drops of tincture of opium to be used in syrup and camphor mixture; also for a small phial of tincture of opium and compound spirits of ammonia.”


Before the opium arrived, Ballie treated the patient’s thirst by administering “to the patient some tea from the spout of a teapot.”  In consultation with the other surgeons it was agreed that amputation would be necessary if the patient rallied.  One of their number, Mr. Ayckburn of Wendover, administered pain relief in the form of opium to a total dose of 8 grains, [16] but Lovett grew increasingly weak and died.  Ballie informed the coroner that:


“I am of the opinion that an excess of opium was given according to the circumstances of the case, and that the sudden termination of the case by the death of the patient was attributable to the opium acting upon the nervous system of the patient, who had not rallied from the first shock . . . death was accelerated by the treatment.  The patient did not rally sufficiently during the day to warrant amputation.”


Considering the primitive surgical techniques of the time, I think it highly doubtful that amputation would have produced a beneficial outcome.

During the hearing Ayckburn informed the coroner that he was qualified by experience rather than examination - “I am not a member of the College of Surgeons, nor a Licentiate from the Apothecary’s Company; I have been in practice 25 years.”  Ballie, on the other hand, was at least partly qualified, being a member of the Royal College of Surgeons.


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PETER RICHARD DEWSBURY Sh, L.S.A.


Little is known about Dewsbury the man.  Born at Chester, the 1851 Census locates him and his family (wife, daughter, medical assistant, cook, groom and housemaid) living on Tring High Street.  He was then 48 years of age so his death in 1857 (cause unknown) came at the comparatively early age of 54.  In the Census Dewsbury uses the then fairly novel term ‘General Practitioner’ to describe his occupation, and gives his qualifications as Sh (unknown) and LSA (Licentiate of the Society of Apothecaries).

Dewsbury appears in the press periodically, generally as an expert witness in the cases that required a medical opinion on cause of death.  Such was the case in a pugilistic contest that took place at Wigginton in December 1827.  The rules of such contests allowed for a broad range of fighting including holds and throws of the opponent.  A round ended with one contestant being downed by a punch or throw, whereupon he was given 30 seconds to rest and eight additional seconds to return to the centre of the ring to continue.  Consequently, a fight did not end after a limited number of rounds, but when one participant was unable to continue.

Such a contest between James Kindell and John Olliffe resulted in the death of Olliffe. 
Kindell eventually stood trial at the Hertford Assizes accused of “feloniously killing and slaying John Olliffe, on the 11th of September, at Wigginton.”:

 
“Harding Dell [a labourer] stated, that, on the day in question, there was a feast on Wigginton-green, at which he, the prisoner, the deceased, and about 100 other persons were present.  In the course of the day, the prisoner and the deceased talked about fighting.  The deceased stripped first and on being advised not to fight, said, ‘he must, for he was put upon,’ and then called out to the prisoner, ‘Come, Jemmy, I’m ready for you.’  They then fought: it was a fair stand-up fight, and the prisoner had the worst of it for several rounds.  At length he struck the deceased a severe blow on the left side, which threw him: but they fought three or four rounds afterwards, when the deceased gave in, and died in half an hour.  The body was taken to the house of the sister of the deceased, and a surgeon sent for . . . . 

. . . . Mr. Dewsbury a surgeon at Tring saw the body about eight o’clock on the evening of Tuesday; found him dead; had the clothes stripped off the body; on the left side of the chest, in the abdomen, discovered a considerable bruise, and some slight bruises on the left side of the neck, a fracture, or incised wound; did not attempt to bleed him; attended on the morning of the inquest, and opened the body; on opening the body found a considerable quantity of coagulated blood in the cavities of the abdomen; on removing that fluid discovered a rupture of the spleen, which was quite sufficient to account for the man’s death; believes that violent contraction of the muscles of the spleen might have produced the rupture, but believes this was caused by a violent blow, which in his opinion was the case.”


And then took place a curious turn of events. 
Dewsbury was proceeding to state that he had examined the body of “a man” on the day in question . . . .


“. . . . when, on being asked whether he knew the name and person of the deceased, he replied in the negative; and no witness being forthcoming to prove that the body examined by Mr. Dewsbury was the body of the deceased, John Olliffe, the Learned Judge interposed, and said that a verdict of acquittal must be taken, as there was no evidence of the identity of the body, or, consequently, of the cause of the death of the deceased.  The prisoner was accordingly acquitted.”

Derby Mercury, 12th December, 1827


When the London & Birmingham Railway opened in September 1838, several publishers saw an opportunity to cash in on this novel form of transport by publishing guide books to the line.  As passengers progressed along it, with the help of their travel guide they could compare the view from the carriage window with the writer’s description of the countryside and the towns through which the line passed (or, in the case of Tring, passed at some considerable distance).

Osborne’s Guide (1838) gives a good potted account of Tring at the time including a reference to its Silk Mill, most of which remains in Brook Street.  The “fish pool”, which at the time was much larger than today, was originally used as a pond from which water was drawn to power the mill’s machinery, but by the time of Osborne water power had been replaced by a steam engine.  It is interesting to note the writer’s observations on the health risk posed by the pond:


“By the side of the mill is the temporary residence of the proprietor, with a conservatory, and an extensive fish pool, the rather stagnant nature of which must give rise to much of pernicious effluvia [an unpleasant or harmful odour or discharge]; and considering that Tring is seldom or never without ague [fever], and as the malaria [3] is generally found to result from pools of this character, several of which are in the vicinity, it is to be hoped that, ere long, the proprietors of these sources of pestilence will evince sufficient morality and intelligence to compel the removal of a nuisance so highly dangerous to all the neighbourhood; actually fatal to some, and deeply injurious to the lives and happiness of many innocent people.”


Osborne goes on to describe the effects of the “pernicious effluvia” on the mill workers:


“In the mill there are almost always persons whose haggard looks evince their having lately been afflicted with this terrible disease, evidently consequential to placing employed in a building through which there must, despite all precaution, be continually circulating a portion of the vapour from the pool beneath; the adult patients look bad enough; but the sight of the little children who have lately suffered, with their wretched countenances, death-like colour, and tottering frames, cannot but make the heart of any humane person burn with the keenest anguish.”


And it is here, at the Silk Mill, that we again encounter Mr. Dewsbury, surgeon of Tring:


“The proprietors of the mill pay Mr. Dewsbury, Surgeon, of Tring, £20 a year for inspecting the persons employed in the mill, to insure cleanliness and freedom from disease: after this evidence, we must not attribute the presence of the injurious marsh to a want of feeling in the proprietors, but rather to a want of information on the subject.”


Whether Mr. Dewsbury delivered any real value for his fee is doubtful.  From what Osborne says, those suffering the “ague” exhibited symptoms that were plainly evident, while it is unlikely that Dewsbury had any effective remedy at his disposal to combat the condition.  The affliction, whatever it was, was not airborne as was thought at the time, but was more likely to have been contracted from well water polluted by waterborne bacteria stemming from inadequate (or non-existent) sanitation.  Tring had to wait until the 1870s to receive a mains supply of clean drinking water, and even then many would not pay the water company’s fee for connection to it.

Another case that involved the newly opened London and Birmingham Railway occurred in October 1838 and caused something of a scandal.  The President of the Royal College of Physicians, Sir Henry Halford, had invited a friend, George Lockley, to spend some time with him at his home in the country.  Shortly before arriving at Tring Station on their journey north, Lockley suffered an “apoplectic fit” (a stoke).  The report in the Morning Chronicle continues:


“The train having arrived, the officers were beckoned to one of the carriages, and thus accosted by a venerable-looking personage within: ― ‘Officer, here is a very respectable gentleman, extremely ill. Do take great care of him, and send off immediately for medical advice’ . . . . Did this friend even get out of the carriage?  He did not, but, frightful to relate, actually flew off with the train, leaving his senseless and speechless friend in the open road, and supported in a chair, placed on the cold wet clay, by the hands of the official strangers!  Mr. Lockley was treated with marked humanity and attention by the officers of the railway who conduct the business of that station . . . .”

 
What then transpired varies between newspaper reports, but according the The Atlas


“In about an hour Mr. Dewsbury arrived, and bled Mr. Lockley, who was removed to the town that evening and expired on the 20th ult.  This is Sir Henry’s own statement, called for by the indignant feelings of the profession at his having abandoned his friend and companion, and not attended to him, and applied himself the resources of his art.”


In response to this charge of neglect, Sir Henry claimed that the rules of the College of Physicians prohibited from bleeding (bloodletting), a job that called for a surgeon; as a physician, Halford could only prescribe.  Would bloodletting have helped Mr. Lockley?  Bloodletting was the withdrawal of blood from a patient to prevent or cure illness and disease, or so it was believed based on ancient theory.  But in the days when doctors had little in the way of effective treatment there was a need to be seen to be doing something to treat the patient.  Even if there was no proven medical benefit to be derived from the procedure, its placebo effect should not be overlooked.  Since the modern era of ‘evidence-based’ medicine, the practice of bloodletting has been consigned to the dustbin of discarded treatments.  As for Sir Henry, the scandal surrounding Lockley’s death did him no lasting damage professionally, for he continued to serve as President of the Royal College of Physicians until his death in 1844.


――――♦――――

 
EDWARD POPE M.R.C.S., L.S.A.


In the graveyard extension to the north of the parish church is the grave of Edward Pope, who practiced medicine in the town for some 60 years.  He must have been held in some esteem by the community, for inside the church is a memorial plaque.

 

The Pope family grave, Tring Parish Church.

Memorial plaque to Edward Pope, Tring Parish Church.


Edward Pope (1811-1898) was born at Frome, Somerset.  On leaving school he was apprenticed to his uncle, Dr. Roberts, of Burnham, Bucks.  He studied at Guy’s, St. Thomas’s, and Webb-street, qualifying as M.R.C.S. and L.S.A. in 1834.  Pope settled in medical practice in Tring in 1837 in succession to the late Mr. Firth, and married in the following year.  Sadly, death was a frequent visitor to the Pope household, claiming his wife Catherine in 1875, two daughters and two sons, all in their childhood or infancy.  His son, Dr. Harry Campbell Pope survived him (d. 2nd January, 1906).

During his career, Edward Pope’s name frequently appears in the local press, generally in connection with hearings before the coroner when cause of death needed to be established, but occasionally a report crops up that is out of the ordinary.  The first took place in Aylesbury in February 1847, when an event took place that was to have an extraordinary impact on surgical procedures carried out in the locality. [4]  This from the Bucks Herald:


“On Tuesday last the marvellous effects of the inhalation of the etheric vapour were developed in three extraordinary cases: — the amputation a leg, — the removal of a tumour from the shoulder,— and the extraction of a finger nail, and subsequent application of strong nitric acid as a caustic.  The operations were in each case most successfully performed, and without the slightest sense of pain, in the presence of a large number of gentlemen, both of the profession [including Edward Pope] and of those interested in witnessing the wonderful effects of ether, in the amelioration of human suffering in surgical operations.”


In an age when the serious fracture of a limb usually resulted in amputation, and with no pain-relief available, lightning-quick surgery shortened the almost unimaginably horrific trauma of the amputation.  The screaming patient was typically held down on a wooden bench by “dressers”, who would also assist with ligatures, knives and dressings.  Although not realised at the time, lightning-quick operations also minimised the exposure of tissue to infection.  In the case witnessed by Pope, the patient had sustained injury by slipping on a frosty surface, in consequence of which he . . . .


“. . . . sustained a compound fracture of both bones of the leg.  He was conveyed to the Bucks Infirmary and for some time his life was in danger from severe erysipelas taking place, and abscesses forming throughout the upper part of the leg and thigh, precluded any immediate operation.  A further delay was subsequently permitted with the view of saving as much of the limb as possible, but at length it was found necessary that amputation should take place . . . .Shortly after twelve o’clock the patient was brought into the operating roam, and being placed on the operating table, the administration of the ethereal vapour was then conducted by Mr. Robert Ceely . . . . As it was intended to prolong the influence, the ether was administered gradually, and so as to cause not the slightest inconvenience to the patient.  The full effect was visible in five minutes, when the patient, being in a perfect state of insensibility and muscular relaxation, the operation of removing the limb was commenced by Mr. James H. Ceely, and in one minute and a half the limb was separated, during which time not the slightest sensibility or motion was apparent.  The securing of more more vessels than usual, and the final dressing of the stump, farther occupied nine minutes and a half, the whole operation thus being performed in 11 minutes.”

Bucks Herald 27th February, 1847


There is no further mention of George Kean in the following weeks’ papers, perhaps an indication that he did not succumb to infection that in the days before antiseptic surgery claimed the lives of many who had undergone surgical procedures.

Another unusual event attended by Pope occurred in January 1853.  It concerned clairvoyance, or the ability to gain information about an object, person, location, or physical event through information sensed with the mind.  And here we meet another Tring personality, Gerald Massey, a self taught poet whose writing attracted considerable attention during the mid-19th century.

Money was for ever short in the Massey household and to help balance the books the poet would hold public exhibitions to exploit his wife
’s talents as a noted clairvoyant.  At one such exhibition held at the Commercial Hall in Tring, Rosina Massey commenced by reading from any and every book or paper passed to her from the audience, but with her eyes effectively covered.  In order to prevent collusion or deception, the audience had been asked to provide their own papers for Rosina to read.  She was then placed by Massey into a “mesmeric sleep” (i.e. placed under hypnosis) and although papers in some very small type were handed to her, according to the Bucks Advertiser (21st January 1853) in almost all instances she read with her eyes covered to the perfect satisfaction and astonishment of those present.

Edward Pope, who was in the audience, subsequently wrote to the Editor of the Bucks Advertiser proclaiming Mrs Massey to be a fraud and concluding with  the pertinent question “Why accept a shilling or eighteen pence for exhibiting manifestations of a power which, skilfully applied, would make them [the Masseys] rich beyond the dream of avarice?”, to which one of paper’s readers replied [to Pope] “Why, Sir, you mesmerise upon a large scale, and then find fault with a poor soul that only trades now and then for a crust.”  There was probably truth on both sides of that argument.

Hydrophobia – or rabies, to use its common name
was a real threat to life at a time before this dread disease was brought under control.  Pope must have known the inevitable outcome of rabies, for there was no vaccine at the time with which to fight it [5]:


“DEATH FROM HYDROPHOBIA AT WIGGINTON.— It will be remembered that about two months ago a dog supposed to he rabid was running about in the neighbourhood of Tring for some considerable time, and creating much alarm, until it was at last shot by Mr. E. C. Knight of Tring.  Unfortunately, however, the dog was not killed until several other dogs had been bitten, and two or three persons also.  One of the latter was a boy named Richard Turney, aged ten, living at Wigginton, who took the dog up in his arm and fondled it, when it bit him under his chin.  Hearing afterwards that the dog was supposed to be rabid the day after he was bitten he went to Mr. Pope, surgeon of Tring, who cauterised the wound.

On Friday week the lad‘s father applied to Mr. Pope with respect to his son, who was unwell.  Mr. Pope went at once and visited the boy, who, in his opinion, showed symptoms of hydrophobia.  He sent him some medicine, saw him again the next morning, and advised his removal at once to the West Herts. Infirmary.  This advice was acted upon, but the poor led gradually got worse, and died there on Sunday night.”

Bucks Herald 27th October, 1877


In addition to his role as a general practitioner, Pope also held public appointments as ‘Certifying Surgeon of Factories’, [6] ‘Medical Officer for the Tring District of the Berkhamsted Union’, and ‘Medical Officer for the Aston Clinton District of the Aylesbury Union.’ [7]

Sanitation at the time was poor due principally to the lack of safe sewage disposal.  Thus, in the absence of a mains supply of clean drinking water, water drawn from wells and from brooks was often polluted with faecal matter, which gave rise to the spread of waterborne diseases such as dysentery, typhoid and cholera.  Two reports from 1875 illustrate Pope’s role in combating the problem.

In the first, the tenants of a row of cottages at Aston Clinton were summoned under the Sanitary Act (1866) to show cause why a well, the water in which was so polluted as to be injurious to health, should not be stopped up.  The Inspector for the Rural Sanitary Authority produced for the magistrates a sketch of the premises and pointed out the different drains, cesspools, &c., all of which were unsealed. As a result they drained into the well, thus polluting the water.  At the hearing . . . .


. . . . Dr. Pope of Tring, medical officer, said — I know this property at Aston Clinton.  I have examined the water of the well, which contains a large amount of organic matter and chloride, which can only come into it from sewage.  The water would be injurious to health, if drunk, and at some seasons, when low, it is not even fit for other domestic purposes.

. . . . In reply to the Bench, the Inspector for the Rural Sanitary Authority said complaints had been made also of the pollution of the brook water by ducks and cattle . . . .


Dr. Pope suggested the making of a tank for the brook water, at a point a little higher up than the cottages.  He accounted for the contamination of the well by the overflowing of the cesspools from heavy rains, and possibly also to the inhabitants themselves throwing slops into it.  He had a sample of the water analysed some time ago by Dr. Saunders of London, one of the analysts of the Metropolitan Sanitary Authorities, and he told him it was worse than that of the Thames at London Bridge.”

Bucks Herald 8th May 1875


Some further remarks were made by the magistrates as to the advisability of having a fresh well sunk, in reply to which one of defendant said that their wives were too lazy to draw the water if a well was sunk, preferring instead to go to the brook which is nearer (referring to a brook running in front of the houses).  In conclusion the Bench ordered the well to be stopped up for six months, but made no order regarding the brook.  How public health benefitted from this ruling in the longer term isn’t clear.

The second case also involves cottages at Aston Clinton, this time with unhealthy arrangements for drainage and the removal of human waste:


“SANITARY SUMMONS.—George Keene was summoned by the Sanitary Authority of the Aylesbury Union [7] for not complying with a notice given him to repair the drains of some houses at Aston Clinton, of which he is the owner.  Mr. Newman said he was the inspector of nuisances for Aston Clinton, and produced authority to take proceedings by minute of the Sanitary Authority of the Union.  He further produced plans of the property, showing the state of the drains, and also a copy of the notice served upon the defendant.  He said the defendant refused to make the alterations required, saying that they would do very well.  He was the owner of ten cottages, in one of which he lived.  The drains were in a very bad state.

Mr. Edward Pope, surgeon of Tring, deposed that he had inspected the drains referred to on Tuesday last.  The surface drain behind the cottages was broken.  The drain was made of common unglazed pipes.  The cesspool was open and uncovered, and it ought to be covered and cemented.  The drains were likely to render the air of the cottages foul, and in his opinion they were in a state injurious to health.


The defendant did not appear, and the Bench made an order for the repair of the drains to he carried out within fourteen days.”

Bucks Herald 17th July 1875


In 1899, in the Akeman Street area of Tring, sewage leeching into unsealed wells from which drinking water was drawn resulted in a typhoid outbreak that infected 105 people, taking the lives of nine of them.


――――♦――――

 
CHARLES PERCY GREEN TOWNSEND


Under “Surgeons”, the Tring entry in the Hertfordshire Almanac for 1884 lists “Messrs Pope and Townsend.”  Reports of coroners’ hearings identify Pope’s partner as Charles Townsend, who qualified at Birmingham in 1875 and appears to have practiced at Tring between 1881 and 1885, when his partnership with Pope was dissolved.  Nothing else is known about him.

Townsend’s name appears in the press in connection with the suicide of Thomas Fowler, a labourer aged 60 years, who lived at Buckland.  His wife awoke during the night to find that he had cut his throat.  The newspaper report went on to say that . . . .


Mr. Charles Townsend, surgeon, Tring, said he had attended the deceased for about six months. He was suffering from a very painful disease.  Witness was sent for early on the morning of the 3rd May, to see the deceased, and found him with his throat cut.  The wound was deep, but no large artery was severed.  The windpipe was severed entirely.  Witness sewed up the wound and dressed it, and the deceased became convalescent so far as the actual wound was concerned . . . . The jury returned a verdict to the effect that ‘The deceased died from exhaustion and shock to the system, caused by the wound which he inflicted upon himself on the 3rd May, he being at the time of unsound mind.’”

Bucks Herald 4th June, 1881


――――♦――――

 
RICHARD NICHOLSON LIPSCOMB M.R.C.S. Eng (1855) L.S.A. London (1856)


Most of the personal information available on Richard Lipscomb comes from an obituary:


“Richard Nicholson Lipscomb was a son of Dr. Lipscomb of St. Albans, and a grandson of the Rev. Dr. Nicholson, rector of its Abbey Church.  In 1857 he purchased the medical practice of Mr. Dewsbury.  He occupied as his house and surgery premises in the High-street, since pulled down and now forming part of the Tring Park Estate office, and here his three children were born.  Mr. Lipscomb was never very strong and usually drove in summer in a victoria and in winter in his brougham,
[8] while his professional rival, Mr. Pope, who, although older was much hardier, either rode or drove in an open gig, and their courteous but somewhat distant salutations as they met on their daily rounds had an old-world flavour somewhat reminiscent of Anthony Trollop’s Barsetshire.  In the year 1883, being then not much over 50 years old, Mr. Lipscomb retired from practice, and went to live at Hove, where he has resided ever since.  For the last few years he was more or less of an invalid, and a fall down a steep flight of stairs was the immediate cause of his death.  Mrs. Lipcomb predeceased her husband by some years, as did also his eldest son, but he leaves one son and one daughter to mourn their loss.”

Bucks Herald, 3rd January, 1914


Lipscomb trained at Guys and the Middlesex Hospital, later becoming House Surgeon, Acting Resident Medical Officer, and Medical and Surgical Registrar before coming to Tring (c.1860).  In common with the town’s other medical practitioners, Lipscomb was occasionally called upon to give evidence at coroner’s inquests, such as in the case of
William Allen, a farm labourer, who died while gathering in the hay on a farm at Drayton Beauchamp.

The hay was being loaded onto a cart to be carried to the rickyard and Allen was standing on top of the pile.  Another labourer who was picking up the rakings heard the sound of someone falling, and on going to investigate found Allen lying face downwards on the far side of the cart with his arms under him . . . .


“He was insensible and did not speak, nor did he call out as he fell, or give any warning that he was likely to do so.  He was quite sober.  He had complained once or twice during the day of feeling unwell.  It was very hot working in the fields.  Witness did not think he [Allen] lived two minutes after he found him on the ground.  The horse was standing perfectly still at the time. . . .


Mr. Lipscomb, surgeon of Tring, said he had frequently attended the deceased for asthma, but not lately.  He saw him yesterday; he was then quite dead.  There was a contusion on the fore-part of the head, probably caused by a blow or fall.  His skull was not fractured.  His impression was that there was a rupture of the spinal chord at the back of the neck, which would most likely cause immediate death.  He could not detect any other injuries about the body.  He thought it very likely that the deceased might have taken giddy, which caused him to fall off the load of hay.  Asthma was frequently connected with disease of the heart.  The jury returned a verdict of ‘Accidental death.’”

Bucks Herald of 12th July, 1873


Smallpox was one of the biggest viral killers of the 19th century and Lipscomb played his part in combating the disease with the vaccine at his disposal.

In 1796, physician Edward Jenner discovered that people who had been casually infected with cowpox appeared to become immune to smallpox.  However, cowpox was rare and before the commercial manufacture of vaccine many years later the supply of vaccine depended on its propagation from human to human – if the vaccine “took” on a child’s arm, then nine or ten days later a pustule would form that was then pricked to provide fresh vaccine.  Children of the poor were immunised at no charge and, on returning to clinics for “inspection”, were put “arm-to-arm” with the next batch of children.  But at a time when the risk of transmitting infection such as syphilis was little understood, arm-to-arm vaccination was dangerous.

With the onset of the COVID-19 pandemic, anti-vaxxers – people wholly opposed to vaccinations
were again in the news, this time with regard to COVID-19 vaccination.  But the anti-vaccination movement is not new; it is as old as vaccines themselves.  Widespread vaccination of children began in the 1830s with the passing of the first Vaccination Act, but the voluntary nature of the Act meant that take-up was poor.   A further Act in 1867 strengthened the legislation.   Within seven days of the birth of a child being registered, the registrar was to deliver a notice of vaccination; if the child was not presented to be vaccinated within three months, or brought for inspection afterwards, the parents or guardians were liable to a summary conviction and fine of 20 shillings.

Lipscomb’s role in the smallpox vaccination process resulted in the anti-vaxxers of the day being brought before the magistrates:


James Putnam was next summoned, to show why in several cases he refused to have his children vaccinated, and said he had a remarkably fine healthy child vaccinated, and in eleven days she was a corpse solely in consequence, the doctor certifying that she died from ‘blood poisoning;’ and when he spoke to Mr. Lipscomb about the vaccination of the others, he was told by that gentleman that he would not be answerable that they would not be like the child which died.  He said he could not therefore submit to have his children vaccinated.  He had had twenty summonses in five years, and had appeared there before them and stated his reasons.  He had also done what he could to get the law altered . . . The Chairman made the order.  Mr. Putnam said ‘it is of no use, I shall not have them vaccinated.’”

Bucks Herald 20th June, 1874
 

The public vaccinator


. . . . and this from the Bucks Herald 18th May, 1878:


“Hannah Baldwin and Elizabeth Norwood, of Tring, were charged by Mr. Cook, vaccination-officer, at the instance of the Guardians, with preventing a doctor taking lymph from a child that had been vaccinated on the 17th ult.  Each of them held an infant in her arms, and were with difficulty made to assent to their having done any wrong.—Mr. R. N. Lipscomb, surgeon, appeared in support of the charge, and one of the mothers said he did eight children from the arm of her infant, and she thought that was enough.—Dr. Lipscomb said he was the best judge of that.—They were informed that they were compelled by law to allow of lymph being taken from their children, and the charge was dismissed.”


After many years of protest compulsory vaccination was abolished in 1948.

Continuing the theme of smallpox, as part of the fight against this and other serious infectious disease two hospitals were built near Tring where patients could be treated in isolation from the rest of the community, thereby greatly reducing the risk of contagion.


The Aldbury Infectious Diseases Hospital was opened in December 1879.  Built by the Berkhamsted Sanitary Authority on an isolated site in New Ground Road, the hospital was intended for patients living within the area administered by the Berkhamsted Poor Law Union, which included Tring.  The hospital was managed by the Sanitary Authority until 1898, when the Aldbury Hospital Joint Committee ― made up from members of the Berkhamsted and Tring councils ― took over.  However, in 1900 the Tring Urban District Council decided to build their own isolation hospital.  Lord Rothschild (Lord of the Manor of Tring) offered to donate a 2½ acre site on Little Tring Road on which to build the hospital, while his wife Emma contributed towards building and furnishing costs.  Designed by local architect William Huckvale, the Tring Isolation Hospital was opened by Lord Rothschild on the 19th December 1901.  Following the opening the management committees agreed in principle that scarlet fever and diphtheria patients would be treated at Tring, and small-pox patients at Aldbury.


――――♦――――

 
EDWIN JOSEPH LE QUESNE L.R.C.P.L., M.R.C.S.E.


Information on Edwin Le Quesne is sparse.  He appears to have been born at Jersey, Channel Islands, on the 15th November, 1851.  On the 16th April, 1877, he was admitted Licentiate of the Royal College of Physicians of London – it appears that he was residing at the Metropolitan Free Hospital at the time.  On the 13th June, 1881, Le Quesne married Mary Ann Alice.  A notice appears in the Lancet, 9th December 1881, to the effect that Le Quesne, “Edwin Joseph, L.R.C.P.Lond., M.R.C.S., L.S.A.Lond., has been appointed Medical Officer and Public Vaccinator for the Tring District of the Great Berkhampstead Union, vice Lipscombe, resigned.”

The Rothschild family acquired Tring Park in 1872, and from then until his death in 1915, Nathaniel Rothschild, Lord of the Manor of Tring, was a considerable benefactor to the town.  Among other municipal projects to which he contributed generously were the construction of the Tring Isolation Hospital and the Tring municipal cemetery.  Lord Rothschild’s wife, Emma, was also a benefactor, in particular financing the construction of “Nightingale House”, the nursing home that once stood near the end of Station Road on a site since sold by the N.H.S. for private development.  Lady Emma also contributed generously towards the nursing home’s running costs.

What facilities and services the Nursing Home provided are unclear.  In addition to a district nurse, there are odd clues in press reports that it also provided services approaching those of a cottage hospital.  Writing in 1940, local historian Arthur Macdonald Brown states in his book Some Tring Air that the nursing home was equipped “with a ward for accidents and operations”.

Today road traffic accidents are not that uncommon, but even before the age of the motor vehicle reports of accidents involving ridden horses and horse-drawn vehicles appear in the press from time-to-time.  Usually they stemmed from panic-prone horses being startled and then bolting out of control, such as in the following report.


Joseph Hannell, a tailor from Hemel Hempstead, was one of a party that set out to visit the Tring Museum riding in a horse-drawn wagonette.  On arrival the horse, a mare, was stabled at the Castle in Park Road and her headgear taken off.  When the party left for home at 6-30, it appears the mare’s headgear was not correctly fitted . . . .


“. . . . They had only proceeded a few yards when a man in the road shouted that the bit was out of the horse’s mouth.  The man approached the horse, and placing his hand on the straps running over the head, behind the ears, pulled the bridle over the horse’s head . . . When the bridle was off the mare started off at once, galloping.  Witness was powerless to stop her, and at the top of the street she rushed up against the kerb, which caused the wagonette to be overturned.  He recollected nothing further until he found himself in the Castle, where they were bathing his face.  All the party except Mr. Hannell sen. returned to Hemel Hempstead the same night. . . . It was not more than twenty yards that the horse galloped from the gates to the corner where the wagonette overturned . . . .

. . . . Mr. Joseph Hannell succumbed on Saturday morning to the injuries he received in the accident in Park-road the previous Wednesday evening.  By Dr. Le Quesne’s advice he was removed to the accident ward of the Tring Nursing Home, which, thanks in a great measure to Lady Rothschild’s wise generosity, is held in readiness for the reception of such cases.  Upon examination it was found that Mr. Hannell’s spine was broken, with the result that he was paralysed from the waist downwards.  All that medical science and skilful nursing could accomplish was done to alleviate the unfortunate man’s sufferings, but from the first it was known that it was impossible to avert or even delay his death.  The doctor’s efforts were loyally supplemented by Miss Girardet, the indefatigable district nurse.”

Bucks Herald 29th September, 1900


An emergency ambulance service, skilled paramedics, accident & emergency units staffed by specialist in that field, and ultrasound/X-ray equipment for detecting and examining internal injuries can now be brought to bear on serious accidents, but none of these facilities were available to Dr. Le Quesne.

The next fatality, which occurred in April 1900, was again caused by a horse bolting.  It happened while a field was being harrowed, the harrow being drawn by a team of three horses that were being led by a farm labourer, Shadrach Charles Payne aged 14.  At the inquest into his death it was established that:


“The leader was a young horse.  The harrow was attached to the two hind horses by a chain, which went between them, and the leader was attached to that chain by two chains and hooks.  They had been at work about an hour and were turning at the end of the field when one of the rear horses stepped on the leader’s chain.  This horse jumped forward, broke the middle chain, and ran away.  The deceased had hold of a chafe rein and held onto it with his hand, being dragged ten yards and then falling to the ground.  The chafe rein is a short one, and the deceased was close to the horse’s head.  Deceased fell in front of the horse, which went right over him.”


The lad being badly hurt was sent home and Dr. Le Quesne was called:


Mr. Edwin Joseph Le Quesne said he was a registered medical practitioner, of Tring.  On April 12, about 11a.m., witness visited the deceased, who was up.  Witness assisted to undress him and put him to bed.  He examined him, and found that he was recovering from a state of collapse.  His breathing was laboured and he complained of pain on the right side.  Witness examined his side, but could not find any mark or bruise, or see that a rib was broken.  Deceased commenced coughing up blood, which suggested injury to the lung.  For a day or two deceased improved, but then he became worse and his temperature increased.  In witness’s opinion he was suffering from a ruptured lung.  Witness last saw him alive on Thursday evening, but death took place on the following day.  Deceased told him that the horse kicked him, and he considered that a kick from a horse would produce a rupture of the lung.—The jury returned a verdict of ‘Accidental death’.”

Bucks Herald 28th April, 1900


Despite the apparent seriousness of the injury there appears to have been no medical intervention other than observation.  The same applies to the next accident that also involved a bolting horse, again with fatal consequences.  The deceased was a man aged twenty-three.  At the hearing before the coroner the first witness stated that . . . .


“. . . . on Thursday evening, about 7.15, I was in the Western-road.  I saw the deceased riding a mare in the direction of Aylesbury.  There was a trap coming from the same direction.  I could see that the mare was running away, and the rider seemed to have lost all control over her.  At the time I saw the deceased he was falling from the mare, and was within a few yards of me.  He fell, his side coming in contact with a lamp post, and his head striking the ground with great force.  His nose was badly cut by the fall.  I went and picked him up, but he was unable to stand.  With assistance I took him to Dr. Le Quesne‘s surgery.  He was conscious, but did not say anything as to why the mare bolted . . . .

“. . . . Dr. Le Quesne stated — On Thursday evening the deceased was brought to my surgery, and I saw him on my return about 7.30.  I examined him and found his nose broken, and there was evidence of his having a tremendous blow on the right side, his ribs being smashed, and there was a fearful contused wound on the right hip, also internal haemorrhage.  He brought up the contents of his stomach, and from this it was evident that he had not been drinking.  I helped remove him and attended him until his death at three o’clock on Friday.  The cause of death was internal haemorrhage, the result of injuries occasioned by the fall from the horse.  A verdict was returned accordingly.”

Bucks Herald 15th August, 1891


One forms the impression from this report that an internal haemorrhage, while evident from the patient’s symptoms, was at the time untreatable.

Not all Dr. Le Quesne’s appearances in the press involved fatalities.  This report is from the Bucks Herald, 26th November 1895.


Dr. E. J. Le Quesne, of Tring, is delivering a course of ambulance lessons to males in the Cheddington School-room on Thursday evenings.  Judging by the number of workmen who attend, at least this form of technical instruction, promoted by Bucks. County Council, is appreciated.”


Dr. Le Quesne lived for at least part of his time in Tring at Elm House, the large property that stands in its own grounds at the junction of Tring High Street and Langdon Street.  An auction advertisement for the sale of his furniture suggests that Dr. Le Quesne left the town around 1910 and retired to Jersey.  He died at “Melbury,” Havre des Pas, Jersey in his 68th year on the 24th January 1919.


――――♦――――

 
JAMES BROWN M.B., C.M.Edin.


Judging by his qualifications – Bachelor of Medicine, Master of Surgery (Chirurgiae Magistrum)
James Brown was the first university educated medical practitioner in Tring, his predecessors having progressed through the earlier apprenticeship route.  Brown came to Tring c.1884, first as assistant to Mr. Pope, then as his partner.  On Pope’s retirement, Brown took over the practice.  In addition to his medical duties he was also a long-serving member of the Urban District Council where his opinions and advice, especially upon questions affecting the health and sanitation in the district, were highly valued.  Dr. Brown married Miss Fulton, a sister of the wife of Richardson Carr, agent to Lord Rothschild, and they lived at the large house called “Harvieston” on Aylesbury Road.


Harvieston, Dr. Brown’s residence.


In the age proceeding the motor car, local G.P.s travelled among their rural patients on horseback or in a horse-drawn vehicle.  This meant that besides having to maintain a horse, a groom-cum-coachman was also needed to ensure that the doctor’s transport was available when he required it.  In his memoir Medicine in Tring, Dr. Thalon recalled that for many years a speaking tube ran from the doctor’s house at No. 23 High Street to the groom’s room on the other side of the road.  This was used when the doctor was called out at night and the groom had to get the horse and carriage ready; and horses, being creatures prone to panic, sometimes bolted causing a spill:


“ACCIDENT TO DR. BROWN.―We are sorry to record that Dr. Brown had an unfortunate spill near Aldbury on Sunday morning when out on professional business.  The horse, frightened, it is thought, by some sheep, reared and threw both Dr. Brown and his coachman out.  The doctor was severely shaken and bruised, but Bruce [his coachman] unfortunately dislocated his collar-bone.  We are pleased to say the doctor is about again and Bruce is making satisfactory progress.”

Bucks Herald 6th October, 1900


Returning to serious infectious disease, following an outbreak of smallpox in 1902, accommodation at the Aldbury Isolation Hospital came under pressure:


“HOSPITAL ACCOMMODATION.― In view of the fact that five smallpox patients were already in Aldbury Hospital, which only contained eight beds, the Council considered the question of providing additional accommodation if necessary.  A representative from Messrs. Humphries, Knightsbridge, attended the meeting, and gave particulars as to the cost etc., of erecting temporary iron buildings on the grounds of the Aldbury Hospital, permission for which had been given by the Aldbury Joint Committee.  Two perfectly plain blocks, 40 feet by 20 feet, would cost about £170, and a wood foundation would be about £10 extra.  These in the opinion of Dr. Brown would be quite suitable.  It was resolved ‘That the Hospital Committee be empowered to act in dealing with the erection of temporary buildings and in other ways with the smallpox outbreak.’”

Bucks Herald 29th March, 1902


Following the opening of the Tring Isolation Hospital in 1901, permission for friends/families to visit patients in isolation, especially children, became a bone of contention with those administering the hospital – visiting appears to have been an existing problem at the older Aldbury hospital:


THE ISOLATION HOSPITAL.– On Saturday the scarlet fever patients in the Aldbury Hospital were removed to the new isolation hospital belonging to the Tring Urban District Council, and the Aldbury building was prepared for the reception of some cases which were suspected to be smallpox.  On Sunday afternoon several persons who had been accustomed to go to the Aldbury Hospital to see their children or friends through the window presented themselves at the new hospital gate, but were informed by the porter that the doctor had given orders that no one was to be admitted without an order from him.  Two or three of the men started for Tring to get the necessary permit, but were told by Dr. Brown that the Hospital Committee had decided that no visitors were to be permitted within the hospital grounds.  Great dissatisfaction was expressed at this departure from the rule which had so long obtained at Aldbury.

Bucks Herald 18th January, 1902


Dr. Brown: To allow visiting does away with the whole idea of an isolation hospital.  At Aldbury we have a lot of trouble with visitors, for if we do not watch the whole of the time they had the windows open or were popping through the doors . . . . It was eventually decided that words to the effect that parents would be allowed to visit their children who were seriously ill should be added to the rules.

Bucks Herald 15th February, 1902


Besides his administrative work on hospital committees, Dr. Brown also encountered serious disease in his everyday role as a medical practitioner:


A CASE OF SMALLPOX.– On Tuesday a case of smallpox was notified in Tring.  A young man named George Norwood, living at 26, Albert Street, but working with a gang on the railway cutting near Haddenham in the adjoining county of Bucks, returned to his home on Monday ill.  On Tuesday morning he was seen by Dr. Brown, who thought his symptoms pointed to smallpox.  The doctor at once communicated with the Medical Officer for the district, Dr. W. Gruggen [of whom more later], by whose direction Norwood was the same evening conveyed to the Isolation Hospital at Aldbury.  The two other occupants of the house in Albert Street were put in quarantine, and everything was done to prevent the spread of the disease.  As the patient had not been in contact with anyone outside his home, there was every reason to hope that, thanks to the prompt action of Dr. Brown and the Medical Officer, the infection will not spread.

Bucks Herald 21st March, 1903


In the next case the coroner for the district held an inquiry into the death of Tom Briant, a Tring postman aged 56 who was hard of hearing.  This is an early road traffic accident in the town involving a motor vehicle, and one that would probably be viewed more critically by today’s traffic police than by the town’s police force of 1912.  When interviewed by the police the car’s driver, an Aylesbury dentist, said he saw Briant in the road gathering manure into a bucket.  When asked why he did not stop the driver replied that having sounded his horn he thought the man was going to move out of the way, but not having heard the horn Briant stepped into the path of the car.  He was then struck by the car’s nearside wing and, despite one witness claiming the car was travelling at no more than 10 m.p.h., the vehicle pushed Briant along the road for 12 yards before stopping:
 

. . . . P.C. Endersby, stationed at Tring said he received information of the accident about 11.40 on the morning of March 7th.  He went at once, and found deceased lying in the road, and the car on the right-hand side of the road about 8 inches from the path.  The road was about 16 feet wide at this point.  Witness assisted the doctor to move deceased, who seemed dazed.  He said he never saw or heard the car till he was knocked down, when he clutched the front of the car.  Deceased was apparently pushed along about 12 yards by the car.

By Mr. Wilkins [witness] ― He could see where the dust had been pushed up by the deceased being shoved along . . . .

. . . . Dr. Brown said he received a telegram about 12.25 at Aldbury, and got to Mr. Briant’s house about one o’clock.  He found deceased had a fracture of the left thigh, about the middle of the lower third; and also slight bruises on the right hip and thigh.  It was rather a troublesome fracture to set, and chloroform had to be administered.  Dr. O’Keeffe assisted to set the leg.  There was very little trouble with the leg after it was set.  Witness had attended deceased for 27 years.  He had weak heart muscles.  Between the 7th and the 20th there were no drawbacks, except the discomfort of changing the splints.  On the morning of the 20th deceased was very well.  He said he had not been better for years.  About 10 the some night witness was fetched, but found deceased dead when he got there.  From the description of the symptoms he got from the daughter, he should say death was caused by a clot of blood in the pulmonary artery.  This was not an uncommon thing to happen after an injury or an accident.

Bucks Herald 30th March, 1912


The jury returned a verdict that death was due to a blood clot in the pulmonary artery, the result of being laid up with injuries sustained in the occurrence which was purely accidental.

James Brown died on the 15th December 1914 at his home “Harvieston” on the Aylesbury Road. 
He had lived Tring for some twenty-five years, during which time “his assiduous attention to his professional duties, and his courteous bearing to all, made him popular with all classes.  His work as a doctor naturally brought him much into contact with his poorer neighbours, and his kindness and sympathetic consideration for the humblest of them won for him their lasting esteem.”  He left a widow and three children, two daughters and a son, Andrew, who was killed in action on the 2nd July 1916 while serving as a second lieutenant in the South Staffordshire Regiment.


――――♦――――

 
WILLIAM WARD ANDERSON M.B., B.Ch. Edin.


Dr. Anderson qualified at Edinburgh University
in July 1904 with the degrees of Batchelor of Medicine and Bachelor of Surgery (Ch = Chirurgie, Latin for surgery).  The 1908 edition of Kelly’s Directory for Tring lists him in partnership with Dr. Le Quesne, their practice being in Western Road (possibly Le Quesne’s residence at Elm House).

A local doctor being called out in connection with a murder is unusual, particularly so when the victim is an infant.  This case involved a boy aged about 14 months whose body was discovered weighed down with a brick in a well at Buckland.  Dr. Anderson was called upon to establish the cause of death:


Dr. W. Ward Anderson, practising at Tring, deposed that in response to a message from P.C. Wicks he went to Drayton Mead Farm on November 27 and saw the body of an infant child lying in an outhouse.  On his instructions P.C. Wicks undressed it.  It was a male child, quite dead; rigor mortis had passed off, and the body was very much swollen.  The child had been vaccinated.  On Wednesday he made a post-mortem examination and found that there were ten teeth, indicating an age of a year to 14 months.  The heart chambers were empty, and the muscles of the heart pale in colour.  There was no disease.  The lungs were swollen and contained a mixture of air and water on the surface, and were spongy.  The other organs were healthy and the body had been well nourished and cared for.  All the limbs were normal, and there was no sign of any poison.  From the condition of the lungs he formed the opinion that the child died from suffocation as the result of immersion in water.  He thought it had been in the water about seven or eight weeks.  He was quite satisfied that it was alive when it entered the water.  After the body had been in the water a considerable time it would become swollen with decomposing gases, and then become buoyant and able to lift a weight in the water.  He thought the body would probably rise to the top of the water, if it had the brick produced attached to it, in about a month.  The stains on the clothing probably arose from some iron in the water.”

Bucks Herald 1st December, 1917


The child’s mother was eventually traced.  Her name was  Dora Edith Scott, she was twenty-six years of age, homeless, and working in a munitions factory at Watford.  Having been taken into custody she made the following statement to the arresting police officer:


“I couldn’t get anyone to look after it [her infant].  I tried at ever so many places.  I tried the day nursery, but they were full up, and Mrs. Went, who I was living with, said she couldn’t look after it any longer, as she was not well herself and had one baby of her own.  So I told Mrs. Went that I would try and get it somewhere else.  And I went, and I am sorry to say that I had a little drop of drink that afternoon, as it drove me to drink.  I got down-hearted, and I did away with him.  I did not know what I was doing, or I should not have done it.  I have no husband.  He died before the war, and this child belongs to a soldier.  The soldier took advantage of me, and I had the child.  I saw no more of him, and have not heard of him since before the child was born.  I have one child by my own husband, which my mother has got.  My mother lives at Whelpley Hill, but she would not have this one, as the other is too much for her.  My husband has been dead six years.  He was a native of Chorlywood, and we lived there.  The child’s name was Cyril.”

Bucks Herald, 19th January, 1918


Dora Edith Scott


Following her statement,
Edith was charged with murder and taken into custody.  She was later tried for murder at the Bucks Assizes, found guilty, and sentenced to death.  However, thanks to her solicitor (Mr. R. S. Wood of High Wycombe) who presented a petition to the Home Secretary, her sentence was commuted to “penal servitude for life.”

What became of Dr. Anderson is something of a mystery.  In September 1918 a notice appeared in the Bucks Herald informing patients that he had moved his consulting room from Western Road to Clifton House, Frogmore Street.  After that – to the extent that he can be clearly identified
his last entry in the local press is in September 1920 when a notice was published informing readers that Dr. Anderson’s seat on Tring Town Council had been declared vacant due to his unexplained absence at meetings during the preceding six months.  The British Medical Journal lists a William Ward Anderson as having died on the 10th November, 1955.


――――♦――――

 
CHARLES EDWARD O
KEEFFE L.R.C.P. & S.I.


There’s a dearth of biographical information on Dr. O'Keeffe.  What there is comes from the pen of his former colleague, David Thallon:
 

“He (Dr. O’Keeffe) and Dr Norman Knox, together with Dr Christopher Cole, whose family lived in Tring for several generations, were in partnership until the beginning of the NHS in 1948.   Dr O’Keeffe was, I understand, someone who inspired great confidence and had a wonderful bedside manner.  He treated the more well-off section of the community, while his partner, Dr Carpenter, dealt with the rest.  Lord Rothschild [Walter Rothschild], who was one of Dr O’Keefe’s patients, required him to visit every day.  He was one of the first people in Tring to own a motor car, having previously used a motorbike to do his visits.”


The cases involving physical violence so far referred to have been pugilistic contests where it is reasonable to assume that the participants were willing.  The next case is very different, and although the assailant – Percy John Eggleton of Miswell Farm
was eventually convicted of malicious wounding, the Bucks Herald report suggests that he nearly faced a charge of wilful murder:
 

Dr. C. E. O’Keeffe, Tring, said he was called to the Icknield Way about 4.30 p.m. on Sept. 11, and found a woman lying by the side of the road on her back and unconscious.  Both eyes were closed, and she was bleeding from the head.  On his instructions she was removed to the Tring Nursing Home, where he examined her, and found extensive bruises and cuts about the head, such as might have have been caused by the stone produced.  In consequence of her serious condition he thought it advisable to have her removed to the Royal Bucks Hospital at Aylesbury, and she was conveyed thither on the following day.  She then developed the rigidity of paralysis on the right side, and was still unconscious.  When he examined her on the Icknield Way he noticed blood stains on her underclothing.  At the time he sent her to Aylesbury her injuries were of such a nature that he was doubtful if she would recover.”

Bucks Herald 8th November, 1918


Having been identified, Eggleton was brought to trial at the Herts. Assizes charged with maliciously wounding Susan Carter.  During the trial prosecuting counsel had this to say . . . .


. . . . it was as bad and brutal an assault as his Lordship had ever had to try.  Prisoner dashed out on the high road where this poor old woman of sixty years was walking, set upon her, and inflicted such terrible injuries that for a time her life was despaired of.  The best opinion the doctors could give was that she would never recover from the blows she received.  There was no evidence to show what weapon was used.

Bucks Herald 21st November, 1919


Eggleton was sentenced to 18 months imprisonment with hard labour.

I
n December, 1940, Home Farm was taken over for maternity care after the Lambeth Municipal Maternity Home had been destroyed by bombing.  On the 1st June, 1945, the Tring facility announced that the 1,000th baby had been born there.

Located in Park Road, Home Farm Emergency Maternity Home was run by the staff from the Lambeth Municipal Maternity Home.  Its clientele were mainly  cases sent to Tring by the London County Council, but it also received evacuated mothers-to-be who were billeted in the neighbourhood and it appears to have catered for some at least of the town’s residents.

During the coroner’s hearings referred to in previous cases, medical evidence concerning cause of death had been accepted without question.  However, in the following case – which involved death in childbirth
Dr. O’Keeffe was questioned by a barrister representing the husband and mother of the deceased woman, Vera Mary Catherine Rees (aged 25), who appear to have suspected that Vera’s death may have resulted from negligence:


Dr. C. E. O’Keeffe, of Tring, gave evidence that it was a very difficult labour; the child, which was born dead, weighing over 10lbs., which was very large, especially for a firstborn.  The mother was given a safe dose of chloroform.  After the child was born Mrs. Rees ceased to breathe.  He applied artificial respiration and she started to breathe again, but she again relapsed.  He continued artificial respiration and gave some injections into her heart, to try and stimulate the heart, but these had no effect . . . . He had no doubt that her kidneys, although they showed no evidence of disorder previous to her labour, were not doing their work properly during the last hours of her life.  She was suffering from a poisoning condition from her kidneys, although there was a satisfactory test before her confinement . . . . In reply to lengthy and detailed questioning by Mr. Figg, Dr. O’Keeffe stated that although Mrs. Rees entered the home on May 10th and the birth did not take place till the 16th, it was a perfectly straightforward case.  He had known plenty of women in labour for a week without any complications.”

Bucks Herald 26th May, 1944


The coroner concluded  that death was due to heart failure from the causes outlined in the medical evidence, and he could not see that there was any negligence on anybody’s part.  It is interesting to note in passing that chloroform, which was given to Vera, is no longer used as an anaesthetic due to the relatively high risk of complications, including possible heart failure.

 

Bucks Herald 8th March 1963.  Dr. O’Keeffe obituary.


“Dr Charles Edward O’Keefe who practised in Tring for many years died on Friday aged 83.  His home was Stud Farm, West Leith, Tring.  Born in County Cork, Ireland, he trained in Dublin, qualified in 1902, came to Tring on January 1st 1905 and joined practice with the late Dr Brown.  When Dr Brown died, he took over the practice and was later joined by Dr. H. N. Knox.  Dr O’Keefe served as captain in the RAMC in WWI.  He is survived by his wife who is a former Tring Councillor and two daughters, Mrs Helen Walford and Miss Bridget O’Keefe who is in practice near Norwich.  Funeral was at Tring Church on Wednesday.”


――――♦――――

 

HENRY NORMAN KNOX M.R.C.S.Eng., L.R.C.P.Lond.

 

Henry Norman Knox was born at Dunedin, New Zealand, in 1898.  During the First World War he served with the Durban Light Infantry in German West Africa.  In 1922 he commenced his medical studies at King’s College Hospital, London, graduating in 1928.  He later served at King’s as House Physician and Senior Resident Accoucheur.  In 1930, he joined an old-established practice at Tring, later becoming Senior Partner until his retirement in 1962.

The founding principles of the National Health Service (NHS) were that health services should be comprehensive, universal and free at the point of delivery — a health service based on clinical need, not ability to pay.  The first case involving Dr. Knox, illustrates how ability to pay was a serious concern at local level before the NHS was established in 1948.  It concerns a patient at the Tring Isolation Hospital who contracted double acute mastoiditis [10], a serious condition that required expensive surgery. The Chairman of the Tring Council felt obliged to accept the charge for the procedures without the formal authority to do so:


“The Clerk [of the Council] had received a letter from from Dr. H. N. Knox, of Tring, regarding the case of Patricia Ward, now discharged from the Isolation Hospital at Tring.  He wrote ‘Her complications, double acute mastoiditis, are liable to occur in any infectious case, and necessitate an immediate operation.  In her case Dr. Steele was called in and operated in the emergency.  His charges are not small, if reasonable.  I feel that if in future cases of this description should arise the doctor in charge should be able to call in a London specialist, whose charges would be the same.’

Dr. Knox referred to the necessity of immediate action in such cases, and suggested that the Council should appoint some person who could be consulted first as to action on such an occasion.  He said ‘I went to great trouble in this recent case, giving my time and help in making all arrangements.  My remuneration was nil, except the usual fee. . . No Tring patient has required such an operation before, and it is hoped the occasion will not arise again.’

The Clerk stated some arrangement was required in case of sudden emergency such as the one referred to.  In this case they were fortunately able to get to the child at once, and the Chairman was faced with the difficulty of making up his mind in authorising the operation to be done.  He could not say what the fee would be.  The Chairman had to shoulder the whole responsibility, not knowing what the charge would be to the Council.  It did cause even some delay, which was very dangerous in these cases.”

Bucks Herald on the 6th October 1933


At the meeting the Council voted to authorise the Chairman, or Vice-Chairman, or Clerk to act in future on such occasions.

A coroner’s inquest held at Aylesbury in 1941 referred to Ernest Foulton of Buckland Common who, s
uffering from prolonged intractable pain, took his own life:


Mrs. Nellie Ada Fulton, wife of the deceased man, said that her husband, who was 47 years of age, was by occupation a labourer.  He had been ill for some time and had undergone three operations, the last one was four years ago.  He had been attended by Dr. Knox, of Tring.  Lately he had been in bed and complained of terrible pain in his side and he told her that the pain was getting worse . . . . Her husband possessed a double-barrelled gun which was kept in the front room together with cartridges.

Mrs. Elizabeth Victor Penn . . . . said that at about 9 o’clock she heard a gun shot . . . . She opened her door and saw Mr. Fulton lying on the garden path, with a gun, outside his house . . . . Witness could see that he was wounded in the side.

Dr. Henry Norman Knox, of Tring, stated that Mr. Fulton had been a patient of his for 11 years.  In 1925 he was operated on for internal ulcer.  The operation was not a success and he had been operated on twice afterwards.  He was able to get up again, but suffered from arthritis and had serious abdominal pain and pain in the legs.  The deceased man had asked if he could be operated upon again, but X-ray examination revealed that any further operation could do no good in his case.  Recently he complained of the pain getting worse and witness had administered small doses of morphia when the pain had grown worse.  Foulton had expressed the wish that he could be out of it all, but he never threatened to do anything to himself . . . .

Rose Coles, district nurse, Buckland Common, said that she accompanied Foulton to the Royal Bucks Hospital in the ambulance and administered oxygen on the journey.  But the man died on the way.  She knew Foulton, who had complained to her greatly of his pain . . . .”

Bucks Herald 10th January, 1941


The Coroner recorded a verdict that death was due to an injury, self-inflicted whilst the balance of the deceased’s mind was disturbed.

Tetanus, often referred to as “lockjaw” after its most recognisable early symptom, is a bacterial disease that affects the brain and the nervous system.  The bacteria, which usually enters the body through cuts or grazes, is
commonly found in soil and the manure of animals such as horses and cows.  Although there is no cure for the disease, treatments are available for managing its symptoms and complications until they disappear.  However, the best way to protect against tetanus is to take the vaccine.  Immunisation was introduced in some localities as part of the primary immunisation of infants from the mid-1950s, then nationally in 1961.  Occurrences of the disease in the U.K. are now rare.

In this coroner’s hearing it was concluded that tetanus infection probably entered the victim through an abrasion on his thumb.  The victim, George Puddefoot, a 25-year-old farm labourer, returned home from work on Thursday the 10th April at 5.30 p.m . . . .


“. . . .  and then said that his back was bad, that he ached from the bottom of his back up to his shoulder.  He did not suggest the cause of it.  After she [his mother] had examined and well rubbed his back with liniment she advised him to go to bed.  She visited him during the night.  He had a very restless night.  During the following day she rubbed his back, but it did not improve, and he was restless the following night.  On Saturday morning she called in Dr. Knox, of Tring, who advised his removal to the Grove [Isolation] Hospital, and this was done.  Her son was removed from Grove Hospital to the Royal Bucks Hospital on Tuesday, April 15th.

Dr. M. C. Rothcope, Bridge House, Leighton Road, Linslade, medical officer of Grove Isolation Hospital, stated that on Saturday, April 12th, Puddefoot was admitted at the hospital, with a medical report of suspected cerebro-spinal meningitis . . . . Witness drew off some spinal fluid for laboratory examination and gave him an injection of anti-tetanus serum. Puddefoot was also given other treatment, in case there was any cerebro-spinal infection.  On the following Monday there was some evidence of stiffness of the jaw and muscles.  The report received on the morning of April 15th showed that there were no germs of cerebro-spinal meningitis. Puddefoot was given a further injection of anti-tetanus serum and arrangements were made for his removal to the Royal Bucks Hospital, in case further investigations were required.  He was removed the same day.

Dr. R. K. I. Kennedy, resident medical officer at the Royal Bucks Hospital, stated that on April 16th Puddefoot was in a state of tetanic spasm
[11] and could not open his jaw at all. He was given the appropriate treatment, but became worse and died on Wednesday, April 16th. There was a small abrasion at the base of the left thumb-nail and a small superficial scratch on the left wrist . . . . Death was due to the tetanus, the most probable point of entry of the bacilli might have been the abrasion at the base of the left thumb-nail.”

Bucks Herald 25th April, 1941


Dr. Knox retired after 32 years and was able to enjoy his family, his golf, and his garden for a further 23 years.  His kitchen garden was perfection and a source of much pride to him. 
He lived at Bell View in Park Road and died there on the 6th March, 1985, aged 87 years.


――――♦――――

 

EDWARD MIDDLETON-BROWN B.A., M.D., L.R.C.P., M.R.C.S.


In his memoir of Tring’s doctors, Dr. Thallon says that:


“There were, of course, other medical practices in the town during this time, notably Dr Middleton-Brown.  He practiced from a surgery close to the United Reform church in the High Street.  He was considered very high class and had a French wife as well as three daughters, who were heavily chaperoned.”


Edward Middleton-Brown was born on the 1st May 1879 at Barnstable, Devon.  At an early age he appears to have changed career direction, for having taken a B.A. degree in 1900, he then went on to acquire the medical qualifications of B.C. (Batchelor of Surgery, C = Chirurgie, Latin for surgery) in 1904, M.B. (Batchelor of Medicine) in 1905 and M.D. (Doctor of Medicine) in 1921.  During the First World War he served as a Captain in the Royal Army Medical Corps. The earliest reference to Middleton-Brown in the press suggests that he came to Tring c.1920, a notice in the Bucks Herald dated 24th April, 1920 reading . . . .


Dr. E. Middleton-Brown has been appointed vaccination officer for the district of Tring.


In the next case the deceased, John Cutler, was a builder’s labourer aged 44.  On March 10th he was working at a building site in Grove Road, Tring, when a slab he was helping to move broke, injuring his thumb.  Dr. Knox stitched the wound, and Cutler returned to work.  Towards the end of the month he complained of a pain in his back that had become progressively worse. 
On Sunday the 2nd April Dr. Middleton-Brown was sent for, and on the following day he removed Cutler to the Royal Bucks Hospital.  By Saturday Cutler was complaining of increased pain and he died that evening, his wife being with him:

 
Dr. E. Middleton Brown, Tring, said that he had known Cutler for some years, and his general state of health was quite good.  On March 10th deceased called at his surgery and told and told him he had crushed his thumb whilst he was handling a slab. Witness redressed the wound, which was a lacerated wound round the inner margin of the thumb, and bruising of the base of the thumbnail. He told him to continue to dress it with boracic lint. It did not show any signs of being septic. Witness advised him not to continue work, but Cutler replied that it was his left thumb, and he was unwilling to give up his work. On subsequent occasions Cutler visited the surgery and the thumb appeared to be healing very satisfactorily. On Sunday, April 2nd, witness was called to Cutler’s home. Deceased complained of stiffness and pain in the lower region of his back.  He thought that at the time Cutler had got lumbago, and certain treatment was prescribed and he was advised to stay in bed.  On April 3rd he saw him again, and he complained of his back and neck being stiff and contracted.  The rigidity was very much more marked and became general, and he suspected tetanus. He got his partner to confirm his diagnosis and sent him to the Royal Bucks Hospital. Witness suspected the tetanus was derived from the wound on the thumb, as tetanus usually entered through an open wound . . . .

. . . . Dr. A. A. Miller, house surgeon, Royal Bucks Hospital, Aylesbury, stated that he saw deceased on admission. The top of the wound appeared to be in a gangrenous condition. Dealing with his general condition, he said that deceased was unable to open his mouth.  His neck muscles were in a similar state, whilst the back and lower limbs were very rigid.  Under the anaesthetic the wound was thoroughly cleaned and tetanus anti-toxin was injected.  On April 6th his general condition became much worse and his spasms of tetanus were more frequent.  On the next day he was in a very critical condition, and on Saturday he was visibly down, and he died at 11.55 p.m.  In witness’s opinion death was due to acute tetanus, which arose from the injury to his thumb.  The tetanus, germ had got into the blood through the wound in the thumb.

Bucks Herald 14th April 1933


Having being satisfied that tetanus was its cause, the recorder returned a verdict of
accidental death.

Although his practice was “considered
very high class,” Dr. Middelton-Brown was also involved in police work, such as in this case of death by misadventure.  The deceased was Miss Lydia Mary Wake of Goldfield Mill House, Tring.  Her servant, on returning home from an outing couldn’t locate her mistress.  On searching the house she discovered that the bathroom door was locked and unable to receive an answer she called in a neighbour who forced the door.  Miss Wake was found lying face down and partly submerged in the bath, dead.  The police and a doctor were called.


Dr. Middleton Brown of Tring said he had never attended the deceased professionally.  He was called at 6.5 p.m. on Monday by P.S. Lee to go to Mr. Richard’s house and there he saw deceased lying in a bath face downwards, covered with a towel, and wearing a rubber cap, which had slipped down almost on to the bridge of the nose.  The nose was resting against the sloping end of the hath.  Both arms were bent under the body and the legs bent upwards, the bath being too short for the body to be fully extended.  Underneath the body were a piece of soap and a flannel.  There were no marks of violence on the body.  She had been dead from three to four hours.  The body was quite well-nourished and there were no signs of illness, or operation scars.  P.S. Lee assisted witness in getting the body from the bath and artificial respiration was tried without success.  The primary cause of death was syncope followed by asphyxiation due to drowning.  Deceased probably became faint from trouble with the heart, or anaemia of the brain, the head then dropped below the level of the water, through collapse, which would cause drowning.  Deceased’s face was blue and there was froth at the lips, and she had the appearance of having been drowned.  The possible explanation of deceased being face downwards was that she had struggled to reach a bell in the wall which was quite close to the sloping end of the bath, and that she fell because of being faint.”

Bucks Herald 26th April, 1924


While there may have been a suspicion of suicide in this case, in the next case death was clearly self-inflicted:


“Dearest Marion.—Forgive me. I cannot endure longer. Please thank ever body.—Your broken-hearted Fred.”


This poignant farewell was found written in a loose-leaf notebook on the body of Frederick George Evans, a 45-year-old commercial salesman, which was found lying dead in Stubbings Wood, near Tring:


Dr. Middleton Brown, the police surgeon, deposed to seeing the deceased lying on a bank in Stubbings Wood.  The body was fully clothed with the exception of the hat, which was lying nearby.  The legs and arms were extended and there was a dark stain round the mouth which extended over the chin down the throat.  Inside an attaché case (produced), which was lying near the body, was a 16oz. bottle of Lysol and a cup.  The stains round the mouth looked as though they had been made by a corrosive fluid such as Lysol.

The Coroner: If deceased had taken neat Lysol would it have taken much to kill him? — No, not very much.

Continuing, Dr. Brown said deceased was clutching the grass with one hand and must have suffered a great deal of pain.  Witness was absolutely satisfied that deceased had taken Lysol, and the cause of death was shock.”

Bucks Herald 22nd July, 1932


Although Evans was known to be worried about business matters he had never threatened to take his own life.  However, at the inquest held in the Market House Tring, a verdict of “Suicide during temporary insanity” was returned.

Dr. Middleton-Brown
left Tring in 1956.  He died at the Cottage Hospital, Marlow, in 1960 aged 81, being survived by a widow and three daughters.


――――♦――――

 

MEDICAL OFFICERS OF HEALTH


The doctors referred to in this paper so far have all been general practitioners (or their earlier equivalents).  Although
Medical Officers of Health did not treat patients individually, they were of equal importance to the community, particularly at a time when the town’s sanitation [12] was of a very poor standard.

Although the cause of cholera was at the time unknown, the epidemics that attacked Britain during the 1830s and 1840s spawned what became a public health service.  Local Boards of Health were formed to place water supply; sewerage; drainage; cleansing; paving, and environmental health regulation under a single local body.  An important role that grew out of these changes was that of Medical Officer of Health (MOH), a role that was to play an important part in tackling environmental health issues in the second half of the nineteenth century.  In 1856, the MOH for Bethnal Green, London, described his role thus:

 
“The Instructions to Medical Officers of Health direct them to inquire into, and to report, periodically, upon the physical conditions of the place and people, their vital statistics and sanitary state, the ventilation and drainage of houses, the drinking waters and water supply, the condition of the burial grounds, slaughtering places, and homes of the industrial classes, and to state, on referring to existing evils, what sanitary appliances are best for their mitigation.”


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CHARLES EDWARD SAUNDERS M.D. Aberd., M.R.C.P.Lond., D.P.H.Camb.


Dr. Saunders was Medical Officer of Health for Middlesex and Hertfordshire, an area that included Tring.  The problems that appear to have been of most concern in Tring were the faecal pollution of drinking water and lack of an effective means for disposing of human faecal matter and sewage.  On this latter concern, in 1877 Dr. Saunders published a report on the sanitary ― or rather insanitary ― conditions prevailing in parts of the town in which he refers to squalor that now makes disturbing reading.  On the need for the town to acquire an effective means of sewage disposal he had this to say:


“This necessity can scarcely by better appreciated than by comparing two streets in the Western Road ― Charles Street and Langdon Street ― the one with pail privies, emptied into an open ashpit and having slop-water cesspools; the other having a sewer into which many of its houses can, and do, drain.  The filth and squalor of the one and the decency and order of the other could scarcely fail to show the necessity for a better system of filth removal.  Another place I would refer to is Church Alley.  Here there is a row of 10 privies within about 8 feet of the back-doors of the houses; these privies have pails, and these pails when full, as they usually have been when I have seen them, are emptied into a huge ashpit, also near the back-doors of the houses.”

Sanitary Conditions of Middlesex and Hertfordshire for the year 1877.


When in 1867 the Council first attempted to introduce a system of sewage disposal, not only did it divert water that previously had been used to maintain the level of the Grand Junction Canal as it crossed the Chilterns, but the town’s human waste was deposited in the local canal reservoir.  Much angered by this, the Canal Company applied for an injunction against Tring Council to cease the nuisance.  This, the Council opposed, but the canal company won their injunction.  Dr. Saunders had this to say about the failed scheme:
 

“The Board’s [Town Council’s] first attempt to carry out a scheme of sewage was so singularly disastrous that their efforts for the last five years have been confined to devising means to undo the mischief that was done . . . .

Sanitary Conditions of Middlesex and Hertfordshire for the year 1877.


It’s not clear when exactly Tring acquired an effective sewage disposal system, but news reports suggest it was early in the 1880s.  Dr. Saunders later became Superintendent of the Sussex County Asylum at Haywards Heath.  He died in 1904 following a period of failing health.


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WILLIAM GRUGGEN L.K.Q.C.P.Irel. & L.M., L.F.P.S.Glas., P.H.Dip.Camb.


William Gruggen was appointed Medical Officer of Health to the Local Board (i.e. Town Council) in 1890.  It was a time in which Tring was undergoing significant improvements in sanitation, especially to the provision of clean drinking water and effective sewage disposal.  In line with the
Instructions to Medical Officers of Health referred to earlier, Dr. Gruggen reported periodically on the sanitary conditions that he found in the course of his work.  The following extract, taken from the Bucks Herald, sets out his concerns over poor sanitation and its causal link to the 1891/92 diphtheria outbreak in Tring:

 
The enumerated population of this district is 4,525. During the past year 78 deaths occurred.  Of these, 13 were of children under one year of age and 30 of persons over 60. Zymotic disease [13] caused 12 deaths — 11 from diphtheria and one from diarrhoea.  The death rate (after adding the deaths in the Workhouse at Berkhamsted, belonging to the district) is 17.9 per thousand living.  There were 127 births registered during the year, giving a birth-rate of 25.8 per thousand living.  The deaths of children under one year of age were in the proportion of 102.3 to a thousand births.  This is a considerable improvement upon last year, which itself was better than any year since 1886.

The zymotic death-rate is 2.6 per thousand living.  This high rate was caused by a serious epidemic of diphtheria which occurred in the town during the latter part of the year. Referring to the diphtheria outbreak, Dr. Gruggen states that he had called attention to ‘The unsatisfactory state of the water-closets, from being without a proper water supply.  In hardly any of the closets is water laid on for flushing, hand flushing being relied on, with the result that in most cases they were abominably filthy, and I would in all seriousness and with all respect again call the attention of the Authority to this matter, which in one worthy of their earnest attention.


Another point which I wish to mention is the badly paved end filthy condition of many of the yards attached to the houses in the town.  Puddles of filthy water are to be seen in all directions in these ill-paved surroundings, and it is utterly impossible, were the people ever so willing, to keep these yards decently clean.  There being reason to believe that the germs of diphtheria may find a habitation in a filth-laden soil, and being forced out with the ground air by a rise in the ground water, the necessity for the proper paving, and rendering impervious to air and moisture of the grounds in connection with the dwellings, at once becomes apparent.


Under section 23 of the Public Health Acts Amendment Act, 1890, section 157 of the Public Health Act, 1878, has been extended so as to empower every Urban Sanitary Authority to make bye-laws with respect to the paving of yards and open spaces in connection with dwelling houses: and I would submit that this matter also merits the serious attention of the Authority.  Eight samples of water were sent to me for analysis, of which two were good, one bad, and five doubtful.’

Bucks Herald 28th May 1892


Serious epidemics remained relatively common in an age before vaccination against such diseases as diphtheria were available and freely given, the diphtheria epidemic that Dr. Gruggen refers to his report being an example (a serious typhoid epidemic followed in 1899).

Diphtheria is a potentially fatal contagious bacterial infection.  It is dangerous because the bacteria that cause it produce a powerful toxin (poison) that kills cells in the mouth, nose and throat.  These dead cells accumulate to form a membrane that can attach to the throat and lead to death by choking.  The disease is usually spread between people by direct contact or by droplets through the air, but it can also be spread by touching contaminated objects such as drinking and eating utensils, doorknobs or toys.  It is more prevalent among people living in crowded or insanitary conditions.


Before the development of vaccines and treatments, diphtheria was widespread, mostly affecting children under the age of 15.  Indeed, during the 1930s diphtheria
was the third leading cause of death in children in England and Wales [14] – the outbreak that occurred in Tring in 1891-92 (below) claimed 11 lives.  In 1940, diphtheria became the first vaccine of the bacteriological age to be offered free to British children on a national scale, since when the disease has become uncommon in the U.K.:


THE OUTBREAK OF DIPHTHERIA. Mr. Vaisey [Town Clerk] stated that in accordance with a request made by the Local Government Board, their Medical Officer of Health, Dr. Gruggen, had given a report on the outbreak of diphtheria at Tring.  This report, which was dated the 31st October, stated that up to that day there has been twenty-one cases in twelve families, of which four had proved fatal.

The first case occurred on the 23rd September.  Upon making enquiries he found that the whole family had suffered from sore throats as far back as the 27th August.  With one exception the whole of the family attacked were under the age of fourteen years and all the children but one attended to National School at Tring.  As there were no cases from the outlying district he did not order the school to be closed.  He had now reason to believe the epidemic was subsiding.

He went on to describe the sanitary arrangements of the houses in which the outbreak had visited.  Of the twenty-three houses, nine had water closets which were not properly flushed, and fourteen were in a dirty condition.  He called the attention of the Board to the inefficient mode of hand-flushing, and recommended the use of a siphon tank.  He considered that the diphtheria was propagated from persons by school attendance.  He did not think any suspicion was attached to the milk supply.  He recommended the use of the public water supply in preference to well water, which should be looked on with suspicion.

In the discussion that ensued, the Chairmen regretted that the school had not been closed at the commencement of the outbreak. — Mr. Crouch was in favour of closing the school now, as there was a fresh case on Sunday last.  He mentioned a case where a parent ought to be prosecuted.   Last Sunday week a teacher asked her class if there were any fresh cases, and a girl got up and said that her brother had died of diphtheria that very day.

Bucks Herald 7th November 1891


The Clerk read a long report from Dr. Gruggen, Medical Officer of Health, as to the outbreak of diphtheria at Tring and the insanitary condition of some places in the town.  There had been 35 cases, and in all 11 deaths — many of the victims, but not all, having been scholars at the National School.  Dr. Gruggen specified each case, and the state of the sanitation of the houses in which they were: most of them occurred in November, with a fall in the barometer and rainy weather after dry.  The schools, it was reported, were closed on December 18th for a three week vacation.— Mr. Baines said he should be seeing Dr. Gruggen on Friday, and would inquire as to the desirability of continuing the vacation.  He had two fresh cases of diphtheria to report. — The Board were of opinion that the holidays might with propriety be extended. — The Chairman was of opinion that some of the cases to which Dr. Gruggen called attention were of a serious nature, and that it was necessary to insist on insanitary premises being put into a proper condition.  The Harrow-yard was mentioned as a case in point. — The Clerk stated that Dr. Thorne was of opinion that diphtheria did not arise from insanitation. — Mr. Smith stated that it was reported, and other members confirmed him, that children had been allowed by a person to go and kiss the body of a person who had died from diphtheria, which was regarded as very reprehensible.

Bucks Herald 9th January 1892


Dr. Gruggen continued in office until his death in 1926, which was announced in the Bucks Herald (30th October):

 

DEATH OF DR. W. GRUGGEN.—The death occurred in London on Tuesday week of William Gruggen, of Durban-road, Watford, one of the best known medical men in Hertfordshire.  About ten day before he died he had a paralytic seizure while attending a performance at the Regent Theatre, London, and did not recover.  He was 73 years of age, and leaves a widow and three daughters.

The son of a naval surgeon, Dr. William Gruggen had worked in Hertfordshire between thirty and forty years.  He devoted himself principally to public health work, and was, at the time of his death, Medical Officer of Health to a combined sanitary district that included Watford, Hemel Hempstead, Berkhamsted, Tring, Welwyn, South Mimms, and Barnet Rural District Councils, and Hemel Hempstead Borough Council, and Bushey, Berkhamsted and Chorleywood Urban District Councils.  During the war he joined the Herts Volunteers, and was appointed Battalion Medical Officer.

 
MALCOLM GROSS M.B., B.S., D.P.H.


Malcolm Gross was appointed Assistant Medical Officer of Health for West Suffolk in 1923.  Four years later he succeeded the late Dr. Gruggen becoming Medical Officer of Health for the Hemel Hempstead Rural District Council, an area that included Tring.

Both of his predecessors had expressed their concerns about the insanitary conditions of some of the housing and their surroundings yards in the town, and over 30 years later Dr. Gross was expressing similar concerns:
 

Dr. Malcolm Gross, the medical officer, who could not be present at the Council meeting, wrote that the Council might remember that in December last he put forward for consideration a report on housing conditions and stated that 15 families were in a condition of gross overcrowding.  He also noted the presence of a number of houses of poor construction and advised that reconstruction was desirable.  It appeared likely that in certain of those cases reconstruction was unlikely to be carried out and that alternatively closure would be resorted to, thus making the demand for new housing even greater than before.  It therefore seemed to him that the provision of further housing accommodation in Tring was a subject which merited earnest consideration.  He always regarded the provision of satisfactory housing as the foundation upon which so many other health measures are based and without which much of their value was dissipated.

Bucks Herald 8th November 1929


Diphtheria also remained high on the Medical Officer’s agenda, this from a Town Council meeting held in 1933:


DIPHTHERIA IN TRING AREA.―The Sanitary Inspector reported that there had been three cases of diphtheria, two of tuberculosis and one of pneumonia.  Dr. Gross said that it was a fact that there had been trouble with diphtheria during the past two months, but he did not think they would have any more trouble.  It was very difficult to trace the original source.  Of course, there had been cases round about Tring, and there had only been ten cases during the year.  Really there had been no definite outbreak, which made it all the more difficult to trace, although they had traced one or two cases.  Also they had found that one or two children were carriers.

Bucks Herald, 6th January 1933

 

In an age before the state paid for vaccination it fell to parents to find the money to have their children treated.  Here Dr. Gross proposes a scheme whereby the Council would pay for diphtheria vaccination in eligible cases:
 

The Chairman [of Tring Town Council] mentioned that the Medical Officer had submitted his scheme for diphtheria immunisation, which would be available for children of 1 to 14 years of age, of parents in the Council’s area who could not afford to pay for the treatment privately.  The Council would provide the materials and pay the medical practitioners a fee of 2 shillings for each child treated.

Dr Malcolm Gross said he did not anticipate that a large number would ask for treatment, but he would like the Council to be able to say that the treatment was available for the children of parents who could not afford the treatment privately.  The scheme was adopted in other parts of the county, and in other counties, and very extensively in the big cities.  On the proposition of Councillor Wright, seconded by Councillor Goddard, the scheme was adopted for six months.

Bucks Herald 7th February 1936


Dr. Gross was born in Wandsworth on the 2nd August 1890 and died in Hemel Hampstead in 1970.


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FOOTNOTES

 
1.    A literal translation of “materia medica” (Latin) is medical material or substance.  This term from the history of pharmacy refers to the body of collected knowledge about the therapeutic properties of any substance used for healing, i.e. medicines.
 
2.    LSA: Elizabeth Garrett (later Garrett Anderson) became the first woman doctor to qualify in Britain when she obtained her Licence in 1865 (the Society of Apothecaries immediately amended its regulations to prevent other women obtaining a licence.  It was not until 1876 that the new Medical Act allowed British medical authorities to license all qualified applicants whatever their gender).  Ronald Ross, the second Nobel Prize-winner in Medicine or Physiology (1902), qualified LSA in 1881.
 

3.    The name malaria derived from mal aria (‘bad air’ in Medieval Italian).  This idea came from the Ancient Romans who thought that this disease came from pestilential fumes in the swamps.  The link to mosquitoes and their parasites was not identified until the early twentieth century.
 

4.   
Ether was first used as a general aesthetic by Dr. Crawford Williamson Long at Jefferson, Georgia, USA, on the 30th March 1842.  Long was a physician and pharmacist who learned about the anaesthetic property of ether while a student.  In 1842 he removed a tumour from the neck of a patient who had been anesthetised with ether, but its use was not credited to Long due to his failure to publish the results of the surgery until several years later.  The first true demonstration of ether as an inhalation aesthetic took place on the 16th October1846 by William Morton, a Boston (USA) dentist.
 
5.    Although Pasteur produced the first rabies vaccine in 1885, the disease continues to be fatal following the appearance of its symptoms.
 
6.    The Factory Act of 1833 forbade the employment of children under the age of nine and limited the hours of work for those under eighteen.  This Act required the involvement of the medical profession in factories for the first time.  Any child between the ages of nine and eleven would require a certificate from a doctor stating that the child was eligible to work.  These doctors became known as certifying surgeons.
 
7.    The Aylesbury Union. In 1833 Earl Grey, the Prime Minister, set up a Poor Law Commission to examine the working of the Poor Law System in Britain. In their report the Commission made many radical recommendations to Parliament. As a result, the great Poor Law Amendment Act of 1834 was passed. The Act had significant ramifications for Aylesbury as under the Act parishes had to group together. So was formed the Aylesbury Union in July 1835. This accommodated the needs of 40 parishes and had an elected Board of Guardian of 48 members to oversee its operation. The population of the Union at the 1831 Census was 21,480 (Aylesbury’s population was at the time 5,021).
 
8.    The Brougham was a light four-wheeled vehicle, enclosed with two doors and forward facing window, perfect for everyday use.  The Victoria may be visualised as essentially a brougham with the addition of a coachman’s box-seat, but not enclosed and therefore open to the elements.
 
9.    Before the Medical Act of 1858, there were 19 bodies regulating the UK medical profession.  Thus, it is unsurprising that data derived from the 1841 Census suggests that a third of all doctors in England at that time were unqualified.  Set up by the 1858 Act, the role of the General Council of Medical Education and Registration of the United Kingdom (a.k.a. the GMC) is to take charge of registration and medical education across the UK as well as the publication of a pharmacopoeia (a list available drugs and directions for their use).  Doctors practising medicine in the UK must have registration with a licence to practise.  It is illegal if they practice medicine without it.
 
10.    Mastoiditis is a bacterial infection in the mastoid bone of the skull.  It is a serious condition, especially so in the age before computerized tomography (CT) or magnetic resonance imaging (MRI) could be used to assess the extent of the infection in the mastoid bone, and antibiotics were available to help treat the condition.
 
11.    
Tetanic spasm: a sustained muscle contraction.  In the most common type of tetanus, the spasms begin in the jaw and then progress to the rest of the body.  Some spasms may be severe enough to fracture bones.  In the 1950s it became possible to abolish the tetanic spasms with muscle relaxants and to support the patient’s respiration with mechanical ventilation.
 
12.    Sanitation refers to public health conditions related to clean drinking water and adequate removal, treatment and disposal of human excreta and sewage.

 
13.    Zymotic disease was a 19th-century medical term for acute infectious diseases, especially fevers and contagious diseases such as typhus and typhoid fevers, smallpox, scarlet fever, measles, erysipelas, cholera, whooping-cough, diphtheria, etc. Zyme or microzyme was the name of the organism presumed to be the cause of the disease.
 
14.    Diphtheria: Epidemiology and Prevention of Vaccine-Preventable Diseases, 11th Edition (The Pink Book).

 
15.    Bonner, Thomas Neville (1995). Becoming a Physician : Medical Education in Great Britain, France, Germany, and the United States, 1750-1945. Oxford University Press. p. 167.
 
16.    Grains in medicine formed a part of the apothecaries’ system.  A standard 325 mg tablet of aspirin is equivalent to 5 grains.


 



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