Residents
of Tamworth all know the place known as Wigginton Park. It was called a green
lung for Tamworth and it is a pleasant open area where children can fly their
kites in the summer and ride their sledges when the snow falls thick on the
slopes there in the winter. But many years ago there were just open fields there
and Charles Oakes, who was the Town Clerk of Tamworth in the 18th century,
farmed the land and lived in a small homestead there. Eventually the estate
passed to a man names Alexander Cope. Copes Drive still exists today, as it was
the main thoroughfare to the estate. However, in the following century, the
estate came into the possession of John Clarke and his wife Elizabeth, who
allowed the 45 acre park to revert to grass and planted a variety of trees to
form an attractive small park. They also built a pretty rustic lodge at the end
of Copes Drive, and a small home farm was added on the western side, named
Waterloo, after the famous victory. John Clarke built a pleasant spacious house
there with lofty rooms, a conservatory and a wide staircase. This splendid
building is known to us today as Wigginton Lodge. But unfortunately, John Clarke
M.D. did not have long to enjoy living on his new estate, for he died in 1815
(this is quite important to note, as you will see later), although his wife
Elizabeth continued to live there until her death, when John’s brother Charles
inherited the lodge.
Both of the Clarke’s were eminent surgeons, both specialising in midwifery and diseases of women – and this was in the days when the science of medicine was still rudimentary and most surgeons only just removed from the barbaric (and indeed often performed by barbers). John Clarke M.D. studied children’s ailments also, and no doubt had he lived longer, would have become one of the country’s leading experts in the field. However, it was Charles Mansfield Clarke who achieved more fame, becoming personal physician to Queen Adelaide, wife of King William IV. Their daughter died in infancy, but nonetheless, Charles Clarke was rewarded for his services to womankind by being awarded a baronetcy in 1831 and it was as Sir Charles Mansfield Clarke of Wigginton Lodge that he came to live there. After his death, Wigginton Lodge was eventually bought by a member of the Hamel family.
John Clarke’s Memorial Mystery
In
St. Editha’s Church, there is a memorial to John Clarke. The Tamworth Heritage
Trust
were recently contacted by Dr. Kenneth Ross Hunter, who was enquiring about any
information we may have on the subject of John Clarke for a lecture he was
giving to the Royal College of Surgeons in London. We supplied him with
photographs of Wigginton Lodge and the memorial at St. Editha’s Church. It was
then that we discovered there was an error in the inscription. The memorial
clearly states that John Clarke died on 31st August 1818, when in fact he had
died three years previous in 1815. We have checked the Dunn & Bradstreet
records, and we have enquired from local history expert Peter Edden, and it has
been confirmed that the stonemasons did make a mistake.Illustrations:
Top left: John Clarke M.D. 1760 – 1815
Top right: Wigginton Lodge, once the home of John Clarke and Charles Mansfield Clarke
Bottom left: The memorial to John Clarke in St. Editha’s Church
Botton right: Charles Mansfield Clarke M.D. 1782 - 1857
The story of John Clarke’s medical career is one of brilliance and we are very grateful to Dr. Kenneth Ross Hunter for allowing us to publish a transcript of the lecture he delivered to the Royal College of Surgeons in April 2001.
The FitzPatrick Lecture
4th April 2001
by Dr. Kenneth Ross Hunter
John Clarke (1760 – 1815): one of John Hunter’s Pupils
Given at the Royal College of Physicians of London
(on the occasion of an Admission Ceremony for new Members of the College)
President, Fellows, Members, especially new Members, Guests;
It is customary when giving one of these College lectures to say something about the person whose name it bears. This is particularly appropriate this year as it marks the centenary of the College's acceptance in 1901 of a gift from Mrs. Agnes FitzPatrick to perpetuate the memory of her late husband, Thomas.
He was a Victorian, born in Ireland in 1832. He became a member of The Royal College of Physicians in 1868 and practised successfully in West London. He published several medical papers, but his writings were esteemed more for his books on travel and his skills as a linguist. He is especially remembered for his kindness to his patients and his friends and for his general conviviality.
He had an interest in medical history and on the centenary of John Hunter’s death in 1893 he delivered an address in which he lavished praise on Hunter1, both as a surgeon and as a natural scientist, describing him as one of the most original thinkers and strenuous workers.
We know that his wife was utterly devoted to him. They used to spend long holidays together, travelling on the Continent and she was always able to cope with the short sea crossing from Dover, but when he decided to visit Norway she felt unable to face what she described as “the ocean” so he went alone instead. He wrote back telling her about the smooth, enjoyable voyage to Oslo. She was missing him greatly (they had never been apart for more than two days) so she immediately booked on the next sailing to join him. Every berth was full, the only place was an uncomfortable sofa used by a stewardess whom she bribed to give it up. Then the ship encountered a terrifying gale and they were considerably delayed, but her eventual reunion with her husband made it all worthwhile!2
When Thomas FitzPatrick died in 1900, this loyal wife was keen to honour his memory appropriately and the result was a lectureship on the history of medicine at this College. When it was set up it sparked off a lively correspondence in the British Medical Journal, discussing Britain’s relative neglect of medical history and culminating in a paper by William Osler on the methods of teaching the history of medicine to students at the John Hopkins Medical School.3,4,5,6,7
To turn now to the subject of this evening’s lecture; I’d like to tell you why I became interested in Dr. John Clarke and to tell you what I have found out about his life and work. First, a bit of background: in a sense my interest in Dr. John Clarke was kindled at this very occasion 33 years ago when I was admitted as a member of the College. I had a warm glow, as many of you probably have, basking in the belief that, as the President said earlier; in future you can do things because they are enjoyable, not just in order to pass examinations. However, at the dinner afterwards I was brought back to earth with a bump because my consultant, Dr. Peter Emerson, suddenly turned and said, “Well, now that you've got membership what you going to do for your MD?”
Two years later I was at University College Hospital, working on my MD thesis by studying the new drug, levodopa, in Parkinson’s Disease. One cannot get involved in this disease without becoming fascinated by the life and work of James Parkinson who first described it in 1817. Among other things, I learnt that Parkinson had been one of John Hunter’s pupils, attending Hunter’s lectures on the theory and practice of surgery and taking down notes in shorthand. Many years after Hunter's death it was discovered that Hunter's own notes, from which he had delivered his annual course of lectures, had been plagiarised and then destroyed by his brother-in-law, Everard Home. Therefore the College of Surgeons encouraged former students to come forward with the notes which they had made. One of the best of these contributions was that of James Parkinson which was published in 1833.8 Another very full set of notes was the version recorded by Nathaniel Rumsey, who later became a surgeon in Chesham. Rumsey’s account was published in 1835.9
That is the background to this evening’s lecture; the reason why I happened to be aware of the especial importance of any surviving students' notes from Hunter’s lectures on surgery. By the 1980s, I had completed my training and I was working as a consultant physician in Plymouth. Someone was clearing out a forgotten cupboard when he came across a collection of old books belonging to the Plymouth Medical Society, which is one of the oldest in the country. The books had apparently been locked away in a peripheral hospital to protect them from the blitz in 1941. Among these books was a manuscript, “Notes taken from Mr. Hunter’s lectures on Surgery, 1781 by John Clarke Jnr.” This manuscript is now in the Library of The Royal College of Surgeons of England. Incidentally, this is the only existing version of the lectures which is signed and dated by John Hunter himself.
I decided to try to find out more about this medical student, John Clarke. What became of him? Did he achieve anything of importance? I'd like to tell you about him this evening and I am most grateful to the President and Censors for inviting me to do so.
The story starts in Wellingborough in Northamptonshire where John Clarke was baptised in the parish church on 19th December 1760. He was the eldest son of a local surgeon, also called John.10
After a few years the family moved to London; living in Chancery Lane and John attending St. Paul's School where he was a successful student, particularly in the classics. On 4th March 1779 he obtained his Diploma of Membership of the Company of Surgeons, 11 and in the same year he began to study medicine. During the next four years he attended anatomy lectures and dissections given by Dr. William Hunter and Mr Cruickshank, lectures on medicine, materia medica and chemistry by Dr. Fordyce, lectures on midwifery and related subjects by Dr. Osborn and Dr. Denman and the lectures on surgery about which we have already heard, given by John Hunter.12 At these lectures one of his contemporary students was John Hunter’s nephew Matthew Baillie, someone with whom he was to have a close professional relationship lasting throughout his life.
He soon decided to specialise in midwifery. This was regarded as a new subject; traditionally obstetrics had been in the hands of women with no formal qualifications. The term “midwife” derives from two words in Middle English, “mid” a preposition meaning “with” and “wife” meaning “woman.” In other words, a midwife was someone of either sex who was with a woman during childbirth. During the eighteenth century men-midwives gradually established themselves. At first, they were only present at difficult, complicated births, which usually ended up unfavourably. Therefore generally women were reluctant to accept them. However as men-midwives became more widespread it was slowly realised that their presence and influence could improve outcomes. This increase in the number of men-midwives coincided with a general surfeit of medical men and this lead to controversy involving the College of Physicians. Many physicians felt that if a man-midwife had obtained access to a family during a pregnancy, he would be at an unfair advantage if he later wanted to act as a physician to that family.13 A deep-seated prejudice against men-midwives arose and in 1771 the College revised its statutes and effectively banned from the fellowship anyone who had practised “as an apothecary or obstetrician or as a tradesman.”14
However the rules involving licentiates were less strict and in 1783 the College recognised that there were distinguished practitioners in midwifery possessing high standards of knowledge. Therefore as an alternative to the existing general licences in medicine it decided to grant special licences limited to obstetrics.15 Before granting such a licence, the College insisted that if an applicant was already a member of the Company of Surgeons he must first disenfranchise himself.14 The Company of Surgeons was content to go along with this arrangement as it usually charged a substantial fee for removal! John Clarke left the Company of Surgeons in 1785 and he obtained his licence in midwifery from the College of Physicians in 1787. The Annals of the College record the details. On 2nd March he was examined in physiology and told that he might come back on Saturday 31st March at 3 o’clock. He did so and was examined in pathology. This was satisfactory and he was asked to come back again in quarter of an hour to attend a new Comitia when he was examined and approved in therapeutics. Two days later, on 2nd April the President, Sir George Baker, formally admitted him as a Licentiate in Midwifery.
Midwifery in the eighteenth century was very different from that of today. Clarke wrote poignantly “there is scarcely an individual who has not to lament the loss of some dear relative or connexion in childbed.”16 The problem was not so much the mechanics of labour but the complications afterwards. We know now that the main post-natal complication was infection, but at that time medical science was ignorant of the precise nature of infectious disease.
Clarke's first publication, dedicated to his teachers Dr. Osborn and Dr. Denman, appeared in 1788.17 There is a copy in the Library of the College of Physicians, inscribed “Dr. Baillie from his most sincere friend, the Author.” It was about puerperal fever. This infection had been known to occur sporadically since the time of Hippocrates but by the middle of the eighteenth century, with the introduction of lying-in hospitals, epidemics arose in both France and Britain. This was before the days of hospital league tables, but John Clarke remarked that when, in 1761, a small private lying-in hospital in London had experienced a “very fatal” epidemic “they sometimes buried two women in one coffin to conceal their bad success.”18
The epidemic form of puerperal fever was due to a particular type of Streptococcus which could be transmitted from patient to patient by attendants who carried the germ on their bodies and their clothes. In the eighteenth century doctors were aware of infection or contagion: they realised that certain diseases could be transmitted directly by close contact, but the carrier state was unknown to them. Clarke wrote “it has been a question…whether this be an infectious complaint or not… but it has also arisen as an original disease in private patients, where there had not been any communication with infected persons…however my experience on the subject is by much too concentrated to speak with any thing like decision on this head.”19 Seven years later Alexander Gordon demonstrated the role of birth attendants in spreading the disease20 and it is clear that Clarke accepted this explanation and acted upon it because later, when it appeared among his patients, “he was induced to destroy his entire wardrobe, and no case of the kind occurred to him afterwards.”21
Clarke's paper was favourably received, indeed it was even translated into German,22 and there was an encouraging review in one of the journals of the time: “we take the liberty of recommending to Mr Clarke to pursue the subject unremittingly, and particularly to endeavour to determine, in what consists the difference in the prevailing fevers of the season attacking women in child-bed.”23
He did pursue the subject and although it was about another century before the germ theory led to progress in prevention and about a century and a half before the first successful treatment with sulphonamides, in retrospect we can see that several of his observations were significant. For example, we now know that the Streptococcus of puerperal fever also causes cellulitis and Clarke mentioned two instances of accidental injury to the hand of someone performing an autopsy after puerperal sepsis. This caused swelling of the arm, lymphadenopathy, fever and a rapid pulse rate.24 He also noted an association between an epidemic of puerperal fever and ulcerous sore throat.25
Clarke quickly built up his reputation as a successful clinician. He was described as having indomitable industry and perseverance and great acuteness of perception. He inspired confidence in his patients and gained the admiration of his colleagues. He was appointed Physician to the Store Street Lying-in Hospital. He was an excellent teacher and his lectures were very popular. In 1789 he married a rich wife, Elizabeth Vaughton of Staffordshire, and he moved from Chancery Lane in the City to Queen Street in the West End.26,27
In 1791 Clarke obtained his MD degree from the University of Frankfurt on the Öder in Prussia.28
In 1793 he published “Practical Essays on the Management of Pregnancy and Labour.”29 He explained that the book had been designed for medical students. He included his earlier work on puerperal fever and also chapters on other complications of pregnancy, antenatal and postnatal care and management of labour. On this occasion the Analytical Review, which had praised his earlier work, was scathingly sarcastic.30 The reviewer pointed out that Clarke himself had written that the work contained nothing new. In which case what was the point of publishing it? “Midwifery has become a kind of vehicle by which the young practitioner has made known the place of his of residence, and his various qualifications. That these trifling considerations could...have any influence…we do not believe; though we have observed some passages…which have somewhat of a suspicious appearance.” Clarke graciously acknowledged the criticism but at the same time he pointed out that the demand for a second edition, which appeared in 1806, indicated the book’s usefulness.
As well as active clinical practice, Clarke took a lively interest in academic matters. He was a member of several learned societies.31 The first was the Lyceum Medicum, which had been set up by John Hunter and Dr. George Fordyce, meeting on Friday evenings at Hunter's Lecture Theatre and Museum near Leicester Square. This had several hundred members, predominantly Hunter's former pupils. Each member was expected to “observe and inquire for himself.” Clinical cases were discussed and dissertations given. The rules of the Society encouraged continuing professional development with fines for inappropriate absence and large fines for failing to deliver papers. Each year four presidents took the chair by rotation. In 1787 Clarke was a president when his colleagues included Dr. Matthew Baillie (Hunter’s nephew) and Mr. Everard Home (Hunter’s brother-in-law).
Hunter had amassed a huge collection of specimens illustrating comparative anatomy and pathology which eventually passed to the Royal College of Surgeons. During the meetings of the Lyceum the more interesting and instructive additions to the museum were displayed. One can imagine one of these meetings being the source of an amusing story about Hunter’s relationship with Clarke.32 Clarke proudly possessed a preparation of an ectopic pregnancy, showing a partially developed foetus in a ruptured Fallopian tube. Hunter had often viewed it with longing eyes. “Come, Doctor,” said he, “I positively must have that preparation.” “No, John Hunter,” was the reply, “you positively shall not.” “You will not give it to me then?” “No.” “Will you sell it?” “No.” “Well then, take care I don't meet you with it in some dark lane at night, for if I do, I'll murder you to get it.”
The Lyceum was a large society. Hunter and Fordyce also founded the Society for the Improvement of Medical and Chirurgical Knowledge, which was a very exclusive one, limited to twelve members at any one time. Clarke was one of these, going to the monthly meetings at Slaughter’s Coffee House in St. Martin's Lane where papers were read, then after dinner they were discussed. The secretary, Dr. Wells assiduously corrected the literary composition of the papers which were published in three volumes between 1793 and 1812. In the seven papers by Clarke in these volumes there are several original observations.
In his first paper, in 1791,33 he reported a case of ectopic pregnancy which ended fatally at seven weeks gestation due to haemorrhage. Clarke recorded that the patient had suffered from nausea due to the pregnancy and he made the point that “sickness of pregnancy depends on the general process going on, and not on the affection of any particular part; at any rate; it has no connection with the residence of the foetus in the uterus.”
His next paper was also about ectopic pregnancy, but this time the pregnancy continued to full term and the patient went into a fruitless labour.34 Even to-day medical science is remarkably ignorant of the precise changes which initiate labour. In 1793, from this case, Clarke deduced that the onset of labour is not due to the presence of a foetus in the uterus.
In 1795 he gave the first ever description of a strangulated diaphragmatic hernia in an adult.35 Clarke thought that, apart from a case due to trauma, described by Ambrose Paré, there had been no earlier adult examples of perforation through the diaphragm. We now know that John Hunter, who had been dead for more than a year, had described this as an incidental finding at autopsy in 1757 in a Royal Marine who had died from osteomyelitis.36
In 1798 he reported an important practical contribution to obstetrics: in difficult cases in which the head presents in the occipito-posterior position, bringing the occiput forward can shorten labour.37
During the next fourteen years at the Society he read three more papers, each on a different uterine disorder.38,39,40
In addition to their own papers members of the Society sometimes presented communications from outside and it is interesting that in 1794 Clarke sponsored an account of the croup in and around Chesham in Buckinghamshire by Henry Nathaniel Rumsey,41 the same man who had earlier, as a student, written the notes of Hunter's lectures which I mentioned earlier.
During this time the Royal Society accepted two papers from Clarke.42,43 The second showed a lively interest in the structure and function of the placenta; a subject which had been of especial interest to John Hunter.
There are many warm contemporary comments about John Clarke and from these we can build up a picture of his personality. He was an efficient, hard worker; successful both as a practitioner and as a teacher. He was gentle and kind. He deplored any roughness or insensitivity during consultations and he emphasised the importance of obtaining consent before internal examinations. Similarly he would obtain consent from the family before performing an autopsy: to quote from one of his papers, “leave was obtained to inspect the body…and the parts involved in the disease were removed, for the purpose of more accurately examining them.”38 He was generous: for example, when the remaining members of the old Lyceum Medicum became honorary members of the new Westminster Medical Society it was John Clarke, along with Matthew Baillie and James Wilson, who arranged for the assets of the Lyceum to be invested separately. They were later donated to the Society for the Relief of Widows and Orphans of Medical men.44
He combined this generosity with sound financial acumen. It cost £80,000 to rebuild the Parish Church of St. Marylebone on a new site opposite the York Gate entrance to Regent’s Park.45 In order to facilitate its completion to coincide with the opening of the Park, in 1812 he gave £10,000, part of which was later to be returned to him as an annuity.46
A young Naval Surgeon, Dr. James Johnson, had a particular reason to appreciate Clarke’s generous nature. It was 1801, the year of the Battle of Copenhagen. His commanding officer, Captain Rogers had turned a blind eye to Johnson’s prolonged absence from his ship –the Mercury - for further study. “But his slender finances were entire exhausted,…being anxious to attend a course of midwifery lectures but not having the means of paying the fee, he stated his circumstances to...Dr. John Clarke…who instantly gave him a free ticket of admission, and invited him to his table.”47
Clarke’s publisher was Joseph Johnson and this suggests that he was inclined to radicalism. He was aware of the link between social deprivation and poor health. He wrote about children in villages suffering fewer diseases than in overcrowded towns.48 He deplored the high death rate among the children of the poor. “Their death, however, makes no noise, and therefore little impression, on account of the obscurity of their station; whilst an unfavourable case of the cow-pox, especially if it occurs in a family of distinction, rings through the whole island with every possible aggravation and misrepresentation.”49
At that time many lying-in hospitals restricted admission to married women, not only because their benefactors were against anything that encouraged vice, but also because hospital managers knew that this lowered death rates.50 Truly destitute women who had no support from their family were more susceptible to infection and death. Clarke felt that these were the very people most in need of care; therefore he supported the policy of his Store Street Hospital which did admit unmarried women, if it was their first pregnancy.51
His attitudes came over in his teachings where he advocated a flexible, sensitive response to patients’ wishes but agreeing to nothing which might compromise their safety.52 His lectures were said to contain a fund of information.27 He gave courses on Midwifery and the Diseases of Women and Children with Dr. Osborn, both at St. Bartholomew’s Hospital53 and at his home in New Burlington Street54 to which he had moved from Queen Street in 1795. There is an interesting parallel with earlier events. Just as the medical student, John Clarke, faithfully recorded his notes from Hunter's lectures on surgery and his teacher signed confirming his attendance, so there is a student’s manuscript in the archives at
St. Bartholomew’s Hospital recording these lectures by Dr. Osborn and Dr. Clarke.53 The lecturers issued certificates of attendance which they signed.
His teaching skills reached a wider audience when he became the author of a successful textbook,55 “The London Practice of Midwifery,” which was first published in 1803. It included a significant section on the diseases of children. Paediatrics did not become a separate specialty until the second half of the nineteenth century. This was a popular work and further editions were published in 1808 and 1811. He used vivid descriptions of individual cases to illustrate general principles, for example he pointed out that labour pains were due to resistance to the expulsion of the foetus. If there was no resistance a woman could give birth with remarkably little pain. “A lady of great respectability, the wife of a peer of the realm, was actually delivered once in her sleep; she immediately awakened her husband, being a little alarmed at finding one more in the bed than was before.”56
As he was held in high esteem his opinion was often sought in difficult cases. For example when “a singular and obscure case of diseased respiration in advanced pregnancy” occurred in Fitzwilliam Square and baffled four doctors in Dublin one of them consulted Dr. Clarke of London by letter.57
There is a graphic description of contemporary obstetric practice in William Godwin’s memoirs of his wife, Mary Wollstonecraft, the controversial feminist.58 He gives a moving account of the events after the birth of her second child who was born in the late evening of Wednesday 30th August 1797. About three hours later, while he was still anxiously waiting downstairs to see the mother and child, he was asked by the midwife to call Dr. Poignand, an obstetrician from the Westminster lying-in Hospital, to deal with a retained placenta. He came and he tried to remove it manually but there was much haemorrhage and he was only partially successful.
On Thursday morning Mary suggested a second opinion from Dr. George Fordyce but Dr. Poignand felt this to be unnecessary and he pointed out that Fordyce was not a specialist in this field. Nevertheless the family called him in. He thought that the patient’s condition was satisfactory but he did arrange to call again daily to make further assessments. On Friday she seemed to improve, but on Sunday she developed rigors. The fragments of retained placenta had clearly become infected. On the following Tuesday Dr. Fordyce brought John Clarke with him and both Dr. Fordyce and Dr. Clarke continued to call every day but it seems that little could be done, except to sedate the patient. By Thursday it appeared that death was imminent, but she clung on to life. The family even had a transient glimmer of hope that she might survive. However this was not to be and she died at twenty to eight on the morning of Sunday 10th September. Happily the baby, also called Mary, survived and when she was sixteen years old, she eloped to the Continent with the poet Percy Shelley. Mary Shelley is probably best remembered now as the novelist who created Frankenstein.
In spite of the unhappy outcome Godwin was clearly grateful to Clarke for his help and when, the year after his wife’s death, he published a collection of her writings in four volumes he presented a copy to him59 with the inscription, “John Clarke,1798, from the editor.”
Then as now obstetrics was an arduous specialty. “Where an error takes place, it is considered always as the fault of the practitioner, and much an unmerited obloquy is apt to be visited on the guiltless head of the medical attendant.”26 Therefore Clarke gradually confined himself to gynaecology and paediatrics. His younger brother, Charles Mansfield Clarke took over his maternity work and he too became a distinguished, successful obstetrician. As physician to Queen Adelaide, he was created a Baronet in 1831. His portrait hangs in the College of Physicians, near the entrance to the Osler Room. One of Clarke's sisters was married to a distinguished physician, Dr. Arthur Stone who was Harverian Orator in 1804, and their son, Thomas, carried on the family tradition by becoming an obstetrician.60
Financial independence meant that in later years he was able to take what we now would call partial early retirement, spending half the year working from his London home, 1 New Burlington Street, just off Swallow Street, which was soon to become redeveloped as Regent Street. His house still stands. The other half of his year was spent in the country, mainly in Staffordshire which had been his wife's home. However he retained his active life style, seeing patients in and around Tamworth if their own doctors were unavailable61 and devoting his energies to persuading the medical establishment of the time that they should pay more attention to the special needs of women and children.
He particularly criticised the bye-law of the College of Physicians which prohibited Fellows from practising midwifery. He felt that this prevented “men of the best education and the highest attainments in learning,” from enlarging the knowledge of the diseases of women and children.49
The College was anxious to prevent unlicensed practice in London and although it had no legal powers to do so, it used to ask apothecaries about the details of prescriptions which they had dispensed, in order to find out if surgeons or accoucheurs were practising beyond their limits by prescribing for purely medical cases. The general licence of the College allowed one to practise physic in London, but the licence in midwifery was limited to the obstetric art. Clarke’s move from obstetrics to gynaecology and paediatrics led him into a dispute with the College. It seems that when Clarke had been admitted to the licence in midwifery in 1787 (after an examination conducted in Latin) he was assured that he would remain eligible to take the general licence later, but a subsequent surreptitious change in the regulations meant that when he applied for the general licence in 1805 the College refused to examine him. He wrote formally to the President and Fellows complaining about poor communication by the College and asking to be allowed to practise as a physician.12 However the College refused to bend its new rules and indeed it even circulated a reminder to its Fellows that a statute existed which imposed a penalty of £5 on any of them who should consult with an illicit practitioner.
His dispute with the College dragged on for several years, and Matthew Baillie, by then one of the most eminent physicians in the country, who had been a College Censor, Goulstonian Lecturer, Croonian Lecturer and Harverian Orator was fined £5 on the evidence of a prescription for consulting with Dr. Clarke.62
The College’s obstinate attitude seems to have been matched by provocative acts by Clarke, for example, when sponsoring one of his students for a degree at St. Andrew’s University in 1804, Clarke described himself as a teacher of midwifery and of the practice of medicine in the diseases of women and children.63 In his will, he firmly described himself as a “Doctor of Physic.”
From a strictly legal view, Clarke probably was practising beyond the limits of his licence but the College was risking ridicule by hounding such a distinguished practitioner. Eventually it was the College's legal advisor, Sir Vicary Gibbs who defused the situation by advising, in 1810 that if the College were to sue him for “practice of Physic beyond the Obstetric art” discussion of the issues in a public Court would be shocking.62
The quarrel with Clarke must have been resolved because in 1814 he was invited to read a paper at the College which was published in Medical Transactions.61 This was a rare honour for a licentiate. It was a clinical description of six cases where women, after childbirth, had suffered neurological problems shortly after eating oysters. Reading the paper now, one can be amused by Clarke’s rather naive theories about how a bulky uterus and a full stomach press upon abdominal vessels diverting blood to the head to cause apoplexy. However when we remember that endocrinology did not emerge as a medical discipline until the second half of the nineteenth century64 and that recognition of links between sex hormones and vascular disease is even more recent, then we can see that some of Clarke's remarks were exceedingly perspicacious. His observations accurately anticipated the protective effect of low doses of oestrogen against arterial disease. “When [monthly periods] cease…the female constitution approaches more to the character of the male, so that it is not very unusual to observe hair grow on the lower part of the face...From this time they become more liable to the diseases, which in earlier periods of life attach almost exclusively to the other sex. Of this kind is apoplexy.”
In 1815 Clarke published the first volume of his book on the diseases of children. Typically he dedicated his book to the medical students who, over the previous thirty years, had attended lectures given initially by Dr. Osborn and Dr. Denman and latterly by himself. He wrote passionately about the high mortality rate among children in London; nearly one quarter dying at less than two years of age.49 He emphasised the importance of this, not just from the medical point of view but also from a political one as a Nation's strength and prosperity depended on its population. He found it impossible to conceive that the high mortality was not due to mismanagement, since “it is utterly inconsistent with the uniform goodness of the Creator, to suppose that so many children are brought into the world only that they may die at an early period of their existence.” In order to provide better information about the causes of death he advocated compulsory issue of medical attendants’ certificates. At that time only Christenings in the Established Church were recorded in the parochial register. Therefore, to ensure complete recording of the total number of births he suggested that Christian dissenters, Catholics, Jews and those of no religion should be included. Civil registration of births and deaths started in England in 1837 but did not become compulsory until 1874, almost 60 years after Clarke’s death. He advocated other public health measures. He criticised the government for accepting the significant taxes levied on the sale of certain medicines, while doing nothing to ensure their quality.65 He wanted stricter control of the spread of contagious disease and recognised that this would need public hospitals, funded at “the national expence” for admitting the poor and separating patients with different diseases.
He particularly advocated strict quarantine for patients with small pox, even if this meant encroachment upon the liberty of the subject. “A man, in a state of society, must be content to surrender some proportion of his own liberty for the advantage of the community in which he lives; and he is only to enjoy so much as is compatible with the good of his neighbour.”49
His book also contained detailed descriptions of various disorders. Chapter Four “On a Peculiar Species of Convulsions in Infant Children” was especially important.66 In 1887 the Dictionary of National Biography stated that this was the work on which his fame rested, ranking him as a medical discoverer;67 one of the founders of child neurology.68 In it he gave an exact description of tetany, in particular carpopedal spasm, distinguishing this from other types of convulsion. He pointed out that the associated paroxysms of spasm in the muscles of the larynx often lead to confusion with respiratory disorders such as chronic croup or asthma, but he concluded that it is “very different from croup, and is altogether of a convulsive character.” He explained that clenching of the first, with the thumb inserted into the palm of the hand, often preceded the development of more florid symptoms. Eleven years later North observed the association between tetany and rickets but a century elapsed before its link with hypocalcaemia was fully worked out.
Sadly, the promised second volume of this book was never published because his life was cut short at only 54 years of age, almost certainly by cancer of the stomach. He was buried in the Parish Church of Tamworth in Staffordshire, where there is a most impressive memorial in white marble by Chantrey bearing the inscription:
Affection’s last tribute
To the best of Husbands & most exemplary of Men.
He remained professionally active to the end. He had, along with Matthew Baillie, been one of the twenty-six founder members of The Medical and Chirurgical Society of London69 now The Royal Society of Medicine, and like Thomas FitzPatrick,70 eighty years later, he was a member of its Council from 1809; becoming vice president in 1814. We can only speculate about possible further contributions to medicine by this diligent student, who meticulously recorded Hunter’s lectures, had he lived longer. But in his relatively short life he accomplished much. He was a pioneer in midwifery, aware of the importance of healthy children to the Nation. His midwifery practice devolved to his younger brother Charles Mansfield Clarke and later to his nephew Thomas Stone. In addition he did much to establish what later became the separate specialty of paediatrics. All this is charmingly summarised in a light-hearted collection of mementos in stonecuttrs’ verse published, under a pseudonym, by William Wadd, in 1827.71
“Beneath this stone, shut up in the dark,
Lies a learned man-midwife, y’clep’d Doctor Clarke.
On earth while he lived, by attending men’s wives,
He increas’d population some thousands of lives:
Thus a gain to the nation was gain to himself;
And enlarg’d population, enlargement of pelf.
So he toil’d late and early, from morning till night,
The squalling of children his greatest delight.
Then worn out with labours, he died skin and bone,
And his ladies he left all to Mansfield and Stone.”
Acknowledgements
I have received enthusiastic and generous assistance from many people and it is a pleasure to acknowledge their help.
Elizabeth Allen, Kurt Bredemyer, Tina Craig, Jo Currie, Geoffrey Davenport, Suzanne Elson, Terry Gould, Andrew Griffin, Michael Handy, Michael Hopkins, Sylvia Huggett, Claire Jackson, Gundolf Keil, Andrzej Ladomirski, Margaret Lattimore, Jean Loudon, Tina McBain, Louise Martin, Yolanda Matlach, Simon May, Trevor McCausland, Ian McDonald, Robert Mills, Margaret Peckham, Patrick Pollak, Michael Reilly, Robert Smart, Holger Stöcker, Cathy Thornton, Claire Tomalin, Alistair Tough, Robert Woof, Stephen Wright.
REFERENCES
1. FitzPatrick T. Centenary of the Death of John Hunter (October 16th, 1893). London: Gilbert & Rivington, 1893.
2. Hartshore A. (Editor). Tours and Excursions on the Continent. Selected from the Diaries of Thomas FitzPatrick, M.D.,M.A.. London, 1901.
3. Anon. The Study of Medical History. Br Med J 1901;ii:1425-6.
4. Biggs MG. The Study of the History of Medicine. Br Med J 1901;ii:1575.
5. Lloyd Owen DC. The Study of the History of Medicine. Br Med J 1901;ii:1637-8.
6. Anon. The Study of Medical History. Br Med J 1902;i:670-1.
7. Osler W. A Note on the Teaching of the History of Medicine, Br Med J 1902;ii:93.
8. Parkinson J. Hunterian Reminiscences; being the substance of a Course of Lectures on the Principles and Practice of Surgery, delivered by the late Mr. John Hunter, in the year 1785. London: Sherwood, Gilbert, and Piper, 1833.
9. Palmer JF. Preface to Lectures on the Principles and Practice of Surgery by John Hunter, F.R.S. In: The Works of John Hunter, ed. JF Palmer. London: Longman, Rees, Orme, Brown, Green, and Longman, 1835:1,201-3.
10. The Register Book of Christenings, Marriages and Burials, in the Parish of Wellingborough, in the County of Northampton: commencing March 26th, 1702. Northamptonshire Record Office 350P/647.
11. Minutes of the Court of Examiners held at the Theatre the 4th march 1779. Archives of Royal College of Surgeons of England.
12. Clarke J. A Memorial to the President & Fellows of the Royal College of Physicians of London, June 25th, 1805.
13. Clark G. A History of the Royal College of Physicians of London. Oxford: Clarendon Press, 1966:2,501-2.
14. Wall C. The History of the Surgeon’s Company 1745-1800. London: Hutchinson’s Scientific & Technical Publications, 1937:153-8.
15. Clark G. A History of the Royal College of Physicians of London. Oxford: Clarendon Press, 1966:2,588.
16. Anon. The London Practice of Midwifery. London: James Wallis, Thomas Cox & Callow, 1803:iv.
17. Clarke J. An Essay on the Epidemic Disease of Lying-in Women of the years 1787 and 1788. London: J. Johnson, 1788.
18. Clarke J. Practical Essays on the Management of Pregnancy and Labour; and on the Inflammatory and Febrile Diseases of lying-in Women. London: J. Johnson, 1793:106.
19. Clarke J. An Essay on the Epidemic Disease of Lying-in Women of the years 1787 and 1788. London: J. Johnson, 1788:32.
20. Loudon I. The cause and prevention of puerperal sepsis. J R Soc Med 2000;93:394-5.
21. Brodie BC. Observation. In: Hutchinson R. Identity of Puerperal Peritonitis with Epidemic Erysipelas. Lancet 1840;ii:193-4.
22. Clarke J. Versuch über die epidemische Krankheit derKinderbetterinnen. Marburg, 1792.
23. Anon. A Review of Clarke’s Essay on the Epidemic Disease of Lying-in Women. Analytical Review 1788;2:54-8.
24. Clarke J. Practical Essays on the Management of Pregnancy and Labour; and on the Inflammatory and Febrile Diseases of lying-in Women. London: J. Johnson, 1793:157.
25. Phillips MH. The History of the Prevention of Puerperal Fever. Br Med J 1938;i:1-7.
26. Nisbet W. Authentic memoirs of the most eminent Physicians and Surgeons of Great Britain. London: Sherwood, Neely and Jones and J. Walker and Highly and Son, 1818:127-130.
27. Munk W. The Roll of the Royal College of Physicians of London. London: Royal College of Physicians, 1861:2,369-71.
28. English Speaking Medical Students attending European Universities in the 17th. Century. Innes-Smith Archive, Royal College of Physicians of Edinburgh.
29. Clarke J. Practical Essays on the Management of Pregnancy and Labour; and on the Inflammatory and Febrile Diseases of lying-in Women. London: J. Johnson, 1793.
30. Anon. A Review of Clarke’s Practical Essays on the Management of Pregnancy and Labour; and on the Inflammatory and Febrile Diseases of lying-in Women of Lying-in Women. Analytical Review 1794;18:186-90.
31. Newton Pitt G. Reflections on John Hunter as a Physician and on his Relation to the Medical Societies of the Last Century. Lancet 1896;i:1270-4.
32. Ottley D. The Life of John Hunter F.R.S. In: The Works of John Hunter, ed. JF Palmer. London: Longman, Rees, Orme, Brown, Green, and Longman, 1835:75-6.
33. Clarke J. History of a fatal haemorrhage from a laceration of the fallopian tube, in a case of an extra uterine foetus. Transactions of a Society for the Improvement of Medical and Chirgurgical Knowledge 1793;1:215-28.
34. Clarke J. Observations on the case of a woman who died with a Foetus in the Fallopian Tube. Transactions of a Society for the Improvement of Medical and Chirgurgical Knowledge 1800;2:1-17.
35. Clarke J. A fatal case of hernia of some of the abdominal viscera strangulated in the cavity of the thorax. Transactions of a Society for the Improvement of Medical and Chirgurgical Knowledge 1800;2:118-31.
36. Allen E, Turk JL, Murley R. (Editors). The Case Books of John Hunter FRS. London: Royal Society of Medicine Services Limited,1993:303.
37. Clarke J. Observations of the Management of cases in which the face of the child presents towards the os pubis. Transactions of a Society for the Improvement of Medical and Chirgurgical Knowledge 1800;2:229-34.
38. Clarke J. Two cases of Tumour of the Uterus. Transactions of a Society for the Improvement of Medical and Chirgurgical Knowledge 1812;3:298-30.
39. Clarke J. On the Cauliflower Excrescence from the Os Uteri. Transactions of a Society for the Improvement of Medical and Chirgurgical Knowledge 1812;3:321-37
40. Clarke J. Case of a Collection of Pus in the Cavity of an unimpregnated uterus. Transactions of a Society for the Improvement of Medical and Chirgurgical Knowledge 1812;3:560-67.
41. Rumsey H. An Account of the Croup, as it appeared in the Town and Neighbourhood of Chesham, in Buckinghamshire, in the years 1793 and 1794. Transactions of a Society for the Improvement of Medical and Chirgurgical Knowledge 1800;2:25-62.
42. Clarke J. Description of an Extraordinary Production of Human Generation, with Observations. Philos Trans R Soc Lond 1793;2:154-63.
43. Clarke J. Account of a tumour found in the substance of the human placenta. Philos Trans R Soc Lond 1798;2:361-68.
44. Routh CHF. The History of the Medical Society of London. Oration to the Medical Society of London (March 8th, 1859).
45. Anon. A Short History of St. Marylebone Parish Church. London, [2001]
46. Papers: 1812-1845. Staffordshire and Stoke-on-Trent Archive Service: Staffordshire Record Office. Reference: 5099.
47. Anon. Biographical Memoir of Dr. James Johnson, Senior Editor of the Medico-Chirurgical Review. The Dublin Journal of medical Science 1839;15:333-40.
48. Clarke J. Commentaries on some of the Most Important Diseases of Children. London: Longman, Hurst, Rees, Orme and Brown, 1815:vii.
49. Clarke J. Commentaries on some of the Most Important Diseases of Children. London: Longman, Hurst, Rees, Orme and Brown, 1815:1-36.
50. Geyer-Kordesch J, Macdonald F. Physicians and Surgeons in Glasgow. The History of the Royal College of Physicians and Surgons of Glasgow 1599-1858. London and Rio Grande: The Hambledon Press, 1999:284.
51. Clarke J. Practical Essays on the Management of Pregnancy and Labour; and on the Inflammatory and Febrile Diseases of lying-in Women. London: J. Johnson, 1793:147
52. Clarke J. Commentaries on some of the Most Important Diseases of Children. London: Longman, Hurst, Rees, Orme and Brown, 1815:149-50.
53. Medvei VC, Thornton JL. The Royal Hospital of Saint Bartholomew 1123-1973. London,1974:49.
54. Announcements. Medical and Physical Journal 1800,4:282-3.
55. The Catalogue of the Library, Royal College of Physicians of London 1912:262.
56. Anon. The London Practice of Midwifery. London: James Wallis, Thomas Cox & Callow, 1803:78.
57. Widdess JDH. A History of the Royal College of Physicians of Ireland 1654-1963. Edinburgh and London: Livingstone, 1963:131.
58. Holmes R. (Editor). Memoirs of the Author of “The Rights of Woman”. London: Penguin Books, 1987:265-73.
59. Woof R, Hebron S, Tomalin C. Hyenas in Petticoats: Mary Wollstonecraft and Mary Shelley. Grasmere: Wordsworth Trust, 1997:66-7.
60. Power D’A. Plarr’s Lives of the Fellows of the Royal College of Surgeons of England. Bristol: John Wright & Sons Ltd., 1930:2,357.
61. Clarke J. On the effects of certain Articles of Food, especially Oysters, on Women after Childbirth. Medical Transactions 1815;5:109-35.
62. Clark G. A History of the Royal College of Physicians of London. Oxford: Clarendon Press, 1966:2,642.
63. M.D. Testimonial for John Waldron. The Muniments, University of St. Andrews, 1804.
64. Weatherall DJ, Ledingham JGG, Warrell DA. (Editors). Oxford Textbook of Medicine (3rd. edition). Oxford, New York, etc.: Oxford University Press, 1996:2,1553.
65. Clarke J. Commentaries on some of the Most Important Diseases of Children. London: Longman, Hurst, Rees, Orme and Brown, 1815:73-5.
66. Clarke J. Commentaries on some of the Most Important Diseases of Children. London: Longman, Hurst, Rees, Orme and Brown, 1815:86-97.
67. Stephen L. (Editor). Dictionary of National Biography, London: Smith, Elder & Co., 1887:10,434.
68. Ashwal S. (Editor). The Founders of Child Neurology. San Francisco: Norman Publishing, 1990:114-9.
69. Moore N, Paget S. The Royal Medical and Chirurgical Society of London Centenary 1805-1901. Aberdeen: University Press, 1905.
70. Anon. Obituary. Thomas Fitz-Patrick. Lancet 1900;i:1762-3.
71. Unus Quorum. Nugae Canorae; or, Epitaphian Mementos (in stone-cutters verse) of The Medici Family of Modern Times. London: Callow and Wilson, 1827:27.