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Recent Acquisition: an Anonymous Medical Manuscript

Autumn, 1999

WHEN the Department of Clinical Biochemistry relocated from the Radcliffe Infirmary last year, Dr Paul Kent transferred to the Museum two manuscript notebooks which had been found there. One is a Minute Book of the University Clinical Club for the years 1930-36. This finds an appropriate home in the Museum, which has records of a number of other University scientific societies; they are an important source of grass-roots information about the study of science at Oxford.

The other manuscript is an anonymous young doctor’s journal for a brief period in 1905. While at first it seemed less promising, a careful reading in the hope of identifying its author has paid unexpected rewards.

The document is an exercise book, only eighteen leaves of which have been written on (and most of those on one side only). Running from the 12th September to the 28th November, the journal is chiefly concerned with notes and observations of medical cases seen by the writer, who is evidently either an advanced medical student or a newly-qualified junior doctor.

The writer undertakes clinical teaching rounds with the Professor of Medicine, William Osler, with whom he also shares an interest in antiquarian books. The references to Osler and accounts of his early ward rounds are the most obviously interesting feature of the document.

Sir William Osler (1849-1919) was one of the great figures in Oxford medicine, as well as a promoter of the history of science. His huge and renowned collection of early medical books is now preserved in his native Canada, at McGill University in Montreal. He was appointed Regius Professor of Medicine in 1904, but arrived in Oxford from America only in May 1905; so what is recorded here is actually the beginning of his first full university term in Oxford.

Osler’s name is revered in medical circles to this day, making references to him which pre-date his establishment as a heroic figure all the more interesting. Nevertheless, his first mention in the journal, on the 15th September 1905, immediately confirms the reputation he had within teaching circles in Oxford: ‘Today I called on Osler who as usual was keen & inspiring; he wants me to take b.p’s [blood pressures] of rowing men during their training as possibly throwing some light on the conditions associated with the transient murmurs they get’.

The writer’s eagerness to learn from the great man, both as medic and as bibliophile, is evident from the notes he makes. On the 5th November he ‘Saw original edition of Burtons Anatomy at Osler’s … Tegg’s edition is the best of recent times which I must get’. On the 8th of the same month he records in some detail, with a diagram, Osler’s teaching clinic on abdominal inspection, showing the great care given to teaching (and learning) the difficult art of tactile examination – of training one’s hands to recognize the body’s inner organs and distinguish between their normal and abnormal states.

On another occasion he notes down one of Osler’s wise and witty sayings: ‘The three qualities of a good medicine “that it be coloured, that it tastes nice and that it does no harm”‘.

While the teaching methods and the evident interest in research suggest an enlightened and modern approach, the journal also contains reminders of the more benighted world in which these medical men were operating. In order to gain experience of a wide range of illnesses, the writer visits various institutions, several of which seem to come from the pages of Dickens.

At the workhouse in Cowley, for instance, ‘the daily task for able bodied men is to break 8 cwt. of stones to such a size as to go through a seive of a certain mesh; the quickest of them sometimes get it done by 11 a.m. working from 7’. Among the patients he examines at the mental asylum at Littlemore are ‘two cases, male & female of Huntingdons Chorea, [and] a case of Lymphadenoma much improved on large doses of arsenic which had to be stopped because of the pigmentation produced’.

The journal also gives insights into the social life of the young doctors of the day, and mentions contemporaries such as Ernest Mallam and Edmund Bevers, who later went on to become well-known in Oxford both as medical practitioners and as university teachers. Along with a student doctor whom he coaches, the writer goes for bicycle rides in the countryside, and also to Woodstock looking at antique furniture.

On a trip to London he studies the original manuscripts of John Ward’s diary in the library of the Medical Society, and comments: ‘It might be used extensively for the study of the conditions of practice & practitioners in Oxford from 1668 to 1678’. The original is now in Washington, and is recognized as an important source for the history of chemistry and medicine in Oxford in the seventeenth century; microfilms held by the Museum have been studied by a number of students and scholars in recent years.

The most unexpected and the most interesting passage in the journal describes a trip with Osler, on the 20th and 21st September 1905, to visit a general practitioner in Burnley, Lancashire:
“Started from Oxford with Osler at 9.5 to Burnley to see Mackenzie. On the way read a new paper by Mackenzie on Angina … Reached Burnley at 3 where was Mackenzie to meet us. After tea saw about half a dozen patients in his surgery chiefly hearts: one in whom a slight anginal attack was brought on by holding his breath.” The writer of the journal goes on to note that he “Saw Mackenzie take tracings some on blackened paper, some by a device of ink made to write on white smooth paper a new method of his. Mackenzie’s hypothesis that irregular pulse never occurs with mitral stenosis & a crescendo murmur being disputed by Osler.” Later he had “Dinner with the family Osler making merry with one of the girls. After the rest had retired had a talk with M about Respiration & pulse. Suggests finding out type of respirn in various chest complaints some people have slow, some quick respirations: why? Some peoples pulses quicken others slow down on respirn.”
The next day there were visits to more of Mackenzie’s patients – ‘heart cases nearly all’ – and after noting their conditions, the writer concludes: ‘To have seen this man (M) & the way he does his work amidst busy general practice including consulting medical work & operating, all his material being his own private patients has been both an education & a stimulus for me’.

This Burnley doctor is therefore none other than Sir James Mackenzie (1853-1925). Though several of his papers and his 1902 book on pulse research had been influential (clearly including on Osler and his young follower), Mackenzie did not become well known in mainstream scientific circles until after he moved to London in 1907. He then established himself as an authority on pain and the interpretation of symptoms, his own focus – seen clearly in this account – being on heart disease and especially angina pectoris.

Mackenzie is known to history, however, for his research upon the heart’s rhythm and its irregularities, and for the graphical recording instrument he invented, with the assistance of a local watchmaker, to record the heart’s pulsations. This is the ‘new method of his’ that is mentioned in the manuscript.

The ‘Mackenzie polygraph’ was subsequently produced commercially, and the Museum happens to have a nice example, dating from about 1910. The polygraph was widely used for clinical and diagnostic purposes. It was perhaps the last significant invention in the field of medical recording before the onset of electronic methods in the following decades.

By a fortunate chance, Osler’s visit to Burnley is referred to in the biography of him by Harvey Cushing. Cushing quotes Mackenzie’s own recollection of the visit: ‘One of Osler’s great charms was the kindly interest he took in obscure workers in any field of medicine; and in 1905 when I was a general practitioner in a remote town in Lancashire he paid me a visit; and though my work was not that in which he was directly interested, yet his appreciation was in itself a very great encouragement’.

Cushing places the visit in July or August, so our document may be the only accurate record of the actual date. More helpful to the Museum’s immediate purpose, however, this event allows the writer of the manuscript to be identified – for we learn from Cushing that Osler’s companion on this trip was A. G. Gibson.

Osler’s companion, Alexander George Gibson (1875-1950), studied at Christ Church. He graduated in 1900, obtaining his B. M. in 1904 after studying at St Thomas’s Hospital, London. In 1905 he returned to Oxford as a junior house physician at the Radcliffe Infirmary, where simultaneously he became Osler’s informal assistant. It is at just this point that he begins to write the diary. Later he also became Osler’s personal physician. Their friendship was so close, and Gibson’s admiration for his mentor so great, that according to Dr A. H. T. Robb-Smith ‘perhaps unknowingly, Gibson assumed some of Osler’s mannerisms’.

Gibson went on to become Pathologist to the Radcliffe Infirmary in 1911; University Lecturer in Morbid Anatomy in 1915; Physician to the Infirmary in 1919; Nuffield Reader in Morbid Anatomy and a Fellow of Merton College in 1937. In the 1920s he was a founder member of the British Cardiac Society, and of the Friends of the Old Ashmolean (the original friends organization of this museum). His history of the Radcliffe Infirmary was published in 1926, and the new pathological laboratories opened at the Infirmary in 1964 were named in his honour.

Cardiology was Gibson’s lifelong interest, and we see it beginning to emerge as such in his journal, not least through Osler’s encouragement and through the ‘education and stimulus’ of the visit to Mackenzie. Gibson was unusual in combining clinical treatment of patients (firstly as a general practitioner and later as a consultant cardiologist) with pathological and post-mortem work, extracting – in the manner of Mackenzie – important research findings from both.

According to Dr Robb-Smith, who was his pupil and has written a more recent history of the Radcliffe hospital, Gibson’s teaching was especially stimulating because of this ‘balance between clinical observations and anatomical findings’. In the same way, at a time of increasing division between treatment and research, ‘he always brought the humanity of the clinician into the laboratory’, and advocated what today would be called a holistic approach to the study and treatment of disease.

As can be seen, this extremely unprepossessing notebook turns out to be an archival object of significant interest. It contains a contemporary record of the important work of Sir James Mackenzie before it received wider recognition, including an early mention of his newly-invented polygraph, and provides insights into the Oxford medical world at the time.

The nature of the clinical teaching and influence of Sir William Osler are illuminated in some detail, as well as the antiquarian interests of Osler and his circle. These antiquarian interests are also of some interest to the Museum, since they had a part in stimulating the development of the history of science in England (including the foundation of the Museum by its first Curator, another of Osler’s admirers, R. T. Gunther).

Not least, the manuscript provides us with an insight into the life of its author, A. G. Gibson himself, an otherwise little-known but nevertheless significant figure in the recent history of Oxford medicine. A. V. S.