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A visit to Thomas Wakley
THE LANCET II I
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A visit to Thomas Wakley David N Evans
Thomas Wakley, founder and editor of The Lancet, is a neglected figure in history. His energies for social and political reform were of major importance in structuring the social framework of Britain in the early Victorian age. He was involved in reforms of the Royal College of Surgeons and the role of the Coroner, registration of the medical profession, Chartism and Electoral Reform, food and drug adulteration, farm-workers' and U n i o n rights, the Tolpuddle Martyrs, and Irish Home Rule. His life in medicine, politics, and as a Coroner touched many famous figures of the Victorian age--Peel, Cobbett, John Hume, Astley Cooper, Charles Dickens, George Eliot, and Thomas Hood. He was a regular figure for satire by Punch in its early days and features in several of their cartoons and satirical writings.
(including to deliver a baby), I was curious about his final resting place. He died in Madeira of puhnonary tuberculosis during a rest-cure on the island. He was embalmed, brought home to England, and laid to rest in All Saints' cemetery, Kensal Green, London. This cemetery was the finest resting-place that Victorian funeral elegance could afford in 1862; the cemetery for dukes, inventors, and dilettantes of the time. My visit to Kensat Green took place in early summer. After preliminary enquiries I was able to pin-point his burial place in the catacombs under the splendid early Victorian temple with its classical grandeur. The staff at Kensal Green were most helpful. Still a private company under the auspices of the General Cemetery Company founded in 1833, it is lovingly tended although somewhat faded in grandeur. Thoughts of late-night horror films loomed large as we descended a stone spiral staircase to a locked barred gate leading to the catacombs. T h e purposebuilt stone and brick cellars have a refrigerated feel to them
Figure 1: Land farm. Thomas Wakley's birthplace
Wakley was born at Land Farm, Membury in a thatched Devon longhouse overlooking the remote Yarty Valley near the small country town of Axminster (figure 1). Axminster, a carpet and market town, is 25 miles equidistant from Dorchester in Dorset, T a u n t o n in Somerset, and Exeter in Devon. He was an ebullient young man, a'farmer's son, and one of ten children. He studied at local schools in Honiton, Chard, and Wiveliscombe, near T a u n t o n , and was apprenticed to a local apothecary. He then walked the wards at the United Borough Hospitals of St Thomas' and Guy's. He abhorred nepotism and humbug, and in a fit of pique against the conservatism of the medical profession at that time, he began to institute medical reforms after founding his illustrious magazine, The Lancet. Our local Medical Society for East Devon honours him by its title---The Wakley Society. We have several Wakleys hereabouts and his descendants have spread all over the globe. After professional visits to his birthplace St Thomas
Court, Church
Street,
(D N Evans MB)
Vol 342 • D e c e m b e r 18/25, 1993
Axmlnster,
Devon EX13
5AG, UK
Figo re 2: Thomas Wakley's coffin "For there is good yet to hear and fine things to be seen Before we go to Paradise by way of Kensal Green." G K Chesterton, The English Rolling Road
1535
THE LANCET
It seems sad that his grave is not more publicly acknowledged. He rests at this 77-acre cemetery with earls, countesses, circus owners, magazine publishers, Robert Owen the Socialist and Co-operative Founder, Sir Marc and Isambard Kingdom Brunel, Thomas Hood, Wilkie Collins, Blondin, and Anthony Trollope. Walking away that day from the catacombs and admiring the mausoleums and gravestones around--few of which, incidentally, exhibit openly Christian symbols---one goes past an elaborate memorial to Long St John Long, a quack Wakley himself brought to book. Long died of the disease he claimed to cure, tuberculosis; the disease and their final resting place are the only things he and Wakley had in common. How ironic that he should have a more fitting and visible memorial in 1993 than Wakley. Perhaps we should rekindle his memory for he was a great reformer and worthy of more public recognition and fame.
and the underground passages were a welcome refuge from the heat of the summer's day. Some of the reveals in which intramural burials took place for the rich and fashionable dead of Victorian times were sealed, some railed, and some open-ended. As the elderly attendant and I searched down the unlit passage for Shelf 13, Vault 59, I hoped Thomas Wakley's last resting place would be the latter. The coffin was there, 7 feet (2 metres) up on the side of the wall. A certain thrill and presence came when the beam from the flashlight illuminated the brass plate on the visible end of the rotted coffin. Here were Thomas Wakley's mortal remains (figure 2). Wiping away the verdigris from the coffin head reveals partly legible writing on a once-ornate brass plaque: " T H O M A S W A K L E Y , Coroner for West Middlesex for 26 years. Member of Parliament for the Borough of Finsbury. Died Madeira, buried June 14th 1862".
Tulp syndrome D Willem Erkelens, Tjerk WA de Bruin, Manuel Castro Cabezas Hypertriglyceridaemia in combination with low highdensity lipoproteins has gained considerable attention in recent years as a major risk for premature atherosclerosis. The nomenclature for this entity is by no means clear or uniform. T h e Fredrickson classification: would list it either under type I, type IV, type V, or even type IIB (leading to the exclamation: " I I B or not IIB? T h a t is the question"). Goldstein and Motulsky's genetic classification~ would call it familial or sporadic combined hyperlipidaemia or hypertriglyceridaemia. T h e matter is confounded further since hypertriglyceridaemia is an essential feature of syndrome X, ~ which was originally described by Vague in 1947 a and which is probably due to inappropriate handling of postprandial fatty-acid metabolism.S We suggest that the syndrome of hypertriglyceridaemia with low high-density lipoproteins be called " T u l p syndrome", although we are aware that coining eponyms is old-fashioned. However, the description of the syndrome by Nicolaes T u l p in 1641 is exceptionally lucid and carries all the essential elements of what we now know about the syndrome. Nicolaes Tulp, Claes Pietszoon, (1593-1674) is known around the world as the demonstrator in Rembrandt's picture, T h e Anatomical Lesson of D r Nicolaes T u l p (1632), currently in the Mauritshuis, T h e Hague. He was a prominent citizen and physician in Amsterdam, who wrote the "Pharmacopoea Amstelredamensis" and "Observationes" in 16417 He later became one of the Burgemeesters of Amsterdam. In 1991 a Dutch translation of the "Observationes" in D r T u l p ' s own handwriting which had been dormant in the archives of T u l p ' s descendants, the Six family, was published. These "Genees insighten" (insights in medicine) were probably written
,gzs,,,3,,,, ,f-,')"-A,
~,,
/'/t,..¢;(_:
~if'/.,~l.¢.- o v a . . ( , . # y ~ J , , ~/a e~
1*,t,~O_,~..-
.Lv,L ,~:/- ;, ,,~,ga o/~',,,~. ~",~-")o# ~n#O,Y,'K
University Hospital Utrecht, PO Box 85500, 3508 GA, Utrecht, Netherlands (Prof D W Erk~lens MD, T W A de Bruin MO, M C Cabezas MD) Correspondence to: Prof D Willem Erkelens
1536
Figure: "Pure milk on t h e blood"
Vol 342 • D e c e m b e r 18/25, 1993
I II II
III
III II
I I II
III I
A visit to Thomas Wakley David N Evans
Thomas Wakley, founder and editor of The Lancet, is a neglected figure in history. His energies for social and political reform were of major importance in structuring the social framework of Britain in the early Victorian age. He was involved in reforms of the Royal College of Surgeons and the role of the Coroner, registration of the medical profession, Chartism and Electoral Reform, food and drug adulteration, farm-workers' and U n i o n rights, the Tolpuddle Martyrs, and Irish Home Rule. His life in medicine, politics, and as a Coroner touched many famous figures of the Victorian age--Peel, Cobbett, John Hume, Astley Cooper, Charles Dickens, George Eliot, and Thomas Hood. He was a regular figure for satire by Punch in its early days and features in several of their cartoons and satirical writings.
(including to deliver a baby), I was curious about his final resting place. He died in Madeira of puhnonary tuberculosis during a rest-cure on the island. He was embalmed, brought home to England, and laid to rest in All Saints' cemetery, Kensal Green, London. This cemetery was the finest resting-place that Victorian funeral elegance could afford in 1862; the cemetery for dukes, inventors, and dilettantes of the time. My visit to Kensat Green took place in early summer. After preliminary enquiries I was able to pin-point his burial place in the catacombs under the splendid early Victorian temple with its classical grandeur. The staff at Kensal Green were most helpful. Still a private company under the auspices of the General Cemetery Company founded in 1833, it is lovingly tended although somewhat faded in grandeur. Thoughts of late-night horror films loomed large as we descended a stone spiral staircase to a locked barred gate leading to the catacombs. T h e purposebuilt stone and brick cellars have a refrigerated feel to them
Figure 1: Land farm. Thomas Wakley's birthplace
Wakley was born at Land Farm, Membury in a thatched Devon longhouse overlooking the remote Yarty Valley near the small country town of Axminster (figure 1). Axminster, a carpet and market town, is 25 miles equidistant from Dorchester in Dorset, T a u n t o n in Somerset, and Exeter in Devon. He was an ebullient young man, a'farmer's son, and one of ten children. He studied at local schools in Honiton, Chard, and Wiveliscombe, near T a u n t o n , and was apprenticed to a local apothecary. He then walked the wards at the United Borough Hospitals of St Thomas' and Guy's. He abhorred nepotism and humbug, and in a fit of pique against the conservatism of the medical profession at that time, he began to institute medical reforms after founding his illustrious magazine, The Lancet. Our local Medical Society for East Devon honours him by its title---The Wakley Society. We have several Wakleys hereabouts and his descendants have spread all over the globe. After professional visits to his birthplace St Thomas
Court, Church
Street,
(D N Evans MB)
Vol 342 • D e c e m b e r 18/25, 1993
Axmlnster,
Devon EX13
5AG, UK
Figo re 2: Thomas Wakley's coffin "For there is good yet to hear and fine things to be seen Before we go to Paradise by way of Kensal Green." G K Chesterton, The English Rolling Road
1535
THE LANCET
It seems sad that his grave is not more publicly acknowledged. He rests at this 77-acre cemetery with earls, countesses, circus owners, magazine publishers, Robert Owen the Socialist and Co-operative Founder, Sir Marc and Isambard Kingdom Brunel, Thomas Hood, Wilkie Collins, Blondin, and Anthony Trollope. Walking away that day from the catacombs and admiring the mausoleums and gravestones around--few of which, incidentally, exhibit openly Christian symbols---one goes past an elaborate memorial to Long St John Long, a quack Wakley himself brought to book. Long died of the disease he claimed to cure, tuberculosis; the disease and their final resting place are the only things he and Wakley had in common. How ironic that he should have a more fitting and visible memorial in 1993 than Wakley. Perhaps we should rekindle his memory for he was a great reformer and worthy of more public recognition and fame.
and the underground passages were a welcome refuge from the heat of the summer's day. Some of the reveals in which intramural burials took place for the rich and fashionable dead of Victorian times were sealed, some railed, and some open-ended. As the elderly attendant and I searched down the unlit passage for Shelf 13, Vault 59, I hoped Thomas Wakley's last resting place would be the latter. The coffin was there, 7 feet (2 metres) up on the side of the wall. A certain thrill and presence came when the beam from the flashlight illuminated the brass plate on the visible end of the rotted coffin. Here were Thomas Wakley's mortal remains (figure 2). Wiping away the verdigris from the coffin head reveals partly legible writing on a once-ornate brass plaque: " T H O M A S W A K L E Y , Coroner for West Middlesex for 26 years. Member of Parliament for the Borough of Finsbury. Died Madeira, buried June 14th 1862".
Tulp syndrome D Willem Erkelens, Tjerk WA de Bruin, Manuel Castro Cabezas Hypertriglyceridaemia in combination with low highdensity lipoproteins has gained considerable attention in recent years as a major risk for premature atherosclerosis. The nomenclature for this entity is by no means clear or uniform. T h e Fredrickson classification: would list it either under type I, type IV, type V, or even type IIB (leading to the exclamation: " I I B or not IIB? T h a t is the question"). Goldstein and Motulsky's genetic classification~ would call it familial or sporadic combined hyperlipidaemia or hypertriglyceridaemia. T h e matter is confounded further since hypertriglyceridaemia is an essential feature of syndrome X, ~ which was originally described by Vague in 1947 a and which is probably due to inappropriate handling of postprandial fatty-acid metabolism.S We suggest that the syndrome of hypertriglyceridaemia with low high-density lipoproteins be called " T u l p syndrome", although we are aware that coining eponyms is old-fashioned. However, the description of the syndrome by Nicolaes T u l p in 1641 is exceptionally lucid and carries all the essential elements of what we now know about the syndrome. Nicolaes Tulp, Claes Pietszoon, (1593-1674) is known around the world as the demonstrator in Rembrandt's picture, T h e Anatomical Lesson of D r Nicolaes T u l p (1632), currently in the Mauritshuis, T h e Hague. He was a prominent citizen and physician in Amsterdam, who wrote the "Pharmacopoea Amstelredamensis" and "Observationes" in 16417 He later became one of the Burgemeesters of Amsterdam. In 1991 a Dutch translation of the "Observationes" in D r T u l p ' s own handwriting which had been dormant in the archives of T u l p ' s descendants, the Six family, was published. These "Genees insighten" (insights in medicine) were probably written
,gzs,,,3,,,, ,f-,')"-A,
~,,
/'/t,..¢;(_:
~if'/.,~l.¢.- o v a . . ( , . # y ~ J , , ~/a e~
1*,t,~O_,~..-
.Lv,L ,~:/- ;, ,,~,ga o/~',,,~. ~",~-")o# ~n#O,Y,'K
University Hospital Utrecht, PO Box 85500, 3508 GA, Utrecht, Netherlands (Prof D W Erk~lens MD, T W A de Bruin MO, M C Cabezas MD) Correspondence to: Prof D Willem Erkelens
1536
Figure: "Pure milk on t h e blood"
Vol 342 • D e c e m b e r 18/25, 1993